Provider Demographics
NPI:1366455479
Name:KELLEY, RALPH R (RPH)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:R
Last Name:KELLEY
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 1:805 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-9476
Mailing Address - Country:US
Mailing Address - Phone:740-532-4000
Mailing Address - Fax:740-533-9633
Practice Address - Street 1:210 CENTER ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1501
Practice Address - Country:US
Practice Address - Phone:740-532-4000
Practice Address - Fax:740-533-9633
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-07108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist