Provider Demographics
NPI:1659034510
Name:KELLEY-ROSS AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:KELLEY-ROSS AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-838-4544
Mailing Address - Street 1:2324 EASTLAKE AVE E STE 400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-6539
Mailing Address - Country:US
Mailing Address - Phone:206-838-4567
Mailing Address - Fax:
Practice Address - Street 1:2120 S PLUM ST STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4539
Practice Address - Country:US
Practice Address - Phone:206-838-4567
Practice Address - Fax:206-838-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACF61232648OtherPHARMACY LICENSE