Provider Demographics
NPI:1407458821
Name:KELLY, JOHANNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:KELLY
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 1:1153 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1868
Mailing Address - Country:US
Mailing Address - Phone:215-257-8200
Mailing Address - Fax:
Practice Address - Street 1:1153 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-1868
Practice Address - Country:US
Practice Address - Phone:215-257-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist