Provider Demographics
NPI:1366963183
Name:EMMONS, ALICE KAYLYN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:KAYLYN
Last Name:EMMONS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-6029
Mailing Address - Country:US
Mailing Address - Phone:606-748-2053
Mailing Address - Fax:
Practice Address - Street 1:118 CLARK ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1207
Practice Address - Country:US
Practice Address - Phone:606-845-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-01
Last Update Date:2017-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist