Provider Demographics
NPI:1053513143
Name:CAULEY, KELLY OLIVIA (RPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:OLIVIA
Last Name:CAULEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 VINE SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-6961
Mailing Address - Country:US
Mailing Address - Phone:919-971-7868
Mailing Address - Fax:
Practice Address - Street 1:2603 VINE SWAMP RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-6961
Practice Address - Country:US
Practice Address - Phone:919-971-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC093771835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric