Provider Demographics
NPI:1073106175
Name:KELLY, PATRICK STEPHEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:STEPHEN
Last Name:KELLY
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 1:7 GREENHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-2018
Mailing Address - Country:US
Mailing Address - Phone:401-874-4027
Mailing Address - Fax:
Practice Address - Street 1:7 GREENHOUSE RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-2018
Practice Address - Country:US
Practice Address - Phone:401-874-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist