Provider Demographics
NPI:1194240218
Name:TIONG, KELLI LEIGH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:LEIGH
Last Name:TIONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4493
Mailing Address - Country:US
Mailing Address - Phone:304-995-6338
Mailing Address - Fax:
Practice Address - Street 1:1102 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3603
Practice Address - Country:US
Practice Address - Phone:304-263-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist