Provider Demographics
NPI:1265816136
Name:KELLEY, AMY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 HUNTERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-5913
Mailing Address - Country:US
Mailing Address - Phone:304-646-2210
Mailing Address - Fax:
Practice Address - Street 1:19258 SENECA TRL
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954-6519
Practice Address - Country:US
Practice Address - Phone:304-799-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV8580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist