Provider Demographics
NPI:1073836615
Name:KELLEY, JILL NICOLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:NICOLE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-3523
Mailing Address - Country:US
Mailing Address - Phone:412-303-9089
Mailing Address - Fax:
Practice Address - Street 1:5121 FOREST RIDGE DR
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-3523
Practice Address - Country:US
Practice Address - Phone:412-303-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043220L183500000X
OH03326679183500000X
WVRP0007070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist