Provider Demographics
NPI:1598230120
Name:KELTY, ALEC (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:KELTY
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 1:3 HUDSON HARBOUR DR APT E
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5346
Mailing Address - Country:US
Mailing Address - Phone:518-421-6957
Mailing Address - Fax:
Practice Address - Street 1:2585 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-7000
Practice Address - Country:US
Practice Address - Phone:845-452-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI064188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist