Provider Demographics
NPI:1003306382
Name:KELLEY, RYAN PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 KAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2724
Mailing Address - Country:US
Mailing Address - Phone:401-439-5132
Mailing Address - Fax:
Practice Address - Street 1:203 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3557
Practice Address - Country:US
Practice Address - Phone:401-307-2555
Practice Address - Fax:401-783-0045
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist