Provider Demographics
NPI:1568686111
Name:KELLEY, KIMBERLY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:KELLEY
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 1:54 BART RD
Mailing Address - Street 2:
Mailing Address - City:N BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-1732
Mailing Address - Country:US
Mailing Address - Phone:978-667-6484
Mailing Address - Fax:
Practice Address - Street 1:71 LOWELL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1709
Practice Address - Country:US
Practice Address - Phone:978-369-5802
Practice Address - Fax:978-369-4532
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist