Provider Demographics
NPI:1497890941
Name:KELLEY-ROSS & ASSOC INC
Entity Type:Organization
Organization Name:KELLEY-ROSS & ASSOC INC
Other - Org Name:UNION CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OFTEBRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:206-622-3565
Mailing Address - Street 1:2324 EASTLAKE AVE E
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3345
Mailing Address - Country:US
Mailing Address - Phone:206-441-9174
Mailing Address - Fax:206-448-4406
Practice Address - Street 1:2324 EASTLAKE AVE E
Practice Address - Street 2:SUITE 405
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3345
Practice Address - Country:US
Practice Address - Phone:206-441-9174
Practice Address - Fax:206-448-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00003637333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4907929OtherNCPDP
WACF00003637OtherSTATE PHARMACY
4907929OtherNCPDP