Provider Demographics
NPI:1376875294
Name:KELLEY, JAMES TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TAYLOR
Last Name:KELLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 POLE LINE RD
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5425
Mailing Address - Country:US
Mailing Address - Phone:208-237-5501
Mailing Address - Fax:208-238-7243
Practice Address - Street 1:3945 POLE LINE RD
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5425
Practice Address - Country:US
Practice Address - Phone:208-237-5501
Practice Address - Fax:208-238-7243
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist