Provider Demographics
NPI:1275892549
Name:KELLY, LINZAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:LINZAY
Middle Name:
Last Name:KELLY
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 1:5353 W SAM HOUSTON PKWY N STE 170
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5191
Mailing Address - Country:US
Mailing Address - Phone:281-619-2050
Mailing Address - Fax:866-300-9797
Practice Address - Street 1:5353 W SAM HOUSTON PKWY N STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5191
Practice Address - Country:US
Practice Address - Phone:281-619-2050
Practice Address - Fax:866-300-9797
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist