Provider Demographics
NPI:1528661501
Name:HADLEY, KAELYN BONER (RPH)
Entity type:Individual
Prefix:DR
First Name:KAELYN
Middle Name:BONER
Last Name:HADLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:KAELYN
Other - Middle Name:BONER
Other - Last Name:HADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1384 COPPERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1268
Mailing Address - Country:US
Mailing Address - Phone:859-361-9982
Mailing Address - Fax:
Practice Address - Street 1:118 E NEW CIRCLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2115
Practice Address - Country:US
Practice Address - Phone:859-254-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist