Provider Demographics
NPI:1285998575
Name:LASH, KELLY DAVID (BA, PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DAVID
Last Name:LASH
Suffix:
Gender:M
Credentials:BA, PHARMD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:D
Other - Last Name:LASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:360 SAILFISH DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2247
Mailing Address - Country:US
Mailing Address - Phone:850-460-5071
Mailing Address - Fax:
Practice Address - Street 1:27 MACK BAYOU LOOP SUITE #1000
Practice Address - Street 2:SACRED HEART MEDICAL ONCOLOGY GROUP
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32549
Practice Address - Country:US
Practice Address - Phone:850-622-0873
Practice Address - Fax:850-622-1054
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50082183500000X
HI1387183500000X
CA42964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist