Provider Demographics
NPI:1326644477
Name:MAHON, KELLY A (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:MAHON
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 1:344 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-2830
Mailing Address - Country:US
Mailing Address - Phone:609-693-7000
Mailing Address - Fax:609-693-3989
Practice Address - Street 1:344 ROUTE 9
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2830
Practice Address - Country:US
Practice Address - Phone:609-693-7000
Practice Address - Fax:609-693-3989
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02032200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist