Provider Demographics
NPI:1073387957
Name:KELLY'S PHARMACY INC.
Entity Type:Organization
Organization Name:KELLY'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DR, RPH
Authorized Official - Phone:518-429-4085
Mailing Address - Street 1:127 BULLOCK RD
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-3404
Mailing Address - Country:US
Mailing Address - Phone:518-429-4085
Mailing Address - Fax:
Practice Address - Street 1:343 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1920
Practice Address - Country:US
Practice Address - Phone:518-429-4085
Practice Address - Fax:518-429-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy