Provider Demographics
NPI:1366799116
Name:KELLEY, TRAM DO (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:TRAM
Middle Name:DO
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 RUE DU BELIER
Mailing Address - Street 2:APT 1506
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6546
Mailing Address - Country:US
Mailing Address - Phone:337-849-0009
Mailing Address - Fax:
Practice Address - Street 1:1630 RUE DU BELIER
Practice Address - Street 2:APT 1506
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6546
Practice Address - Country:US
Practice Address - Phone:337-849-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist