Provider Demographics
NPI:1992302046
Name:KEPRTA, KELLY MARIE (PHARMD RPH)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:KEPRTA
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17014 ARROWS PEAK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6626
Mailing Address - Country:US
Mailing Address - Phone:409-223-2281
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHWAY 290 E
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-5563
Practice Address - Country:US
Practice Address - Phone:979-826-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist