Provider Demographics
NPI:1033715891
Name:KELLEY, TIMOTHY BUDDY (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BUDDY
Last Name:KELLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6123
Mailing Address - Country:US
Mailing Address - Phone:850-871-5525
Mailing Address - Fax:850-871-6307
Practice Address - Street 1:302 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-6123
Practice Address - Country:US
Practice Address - Phone:680-871-5525
Practice Address - Fax:850-871-6307
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist