Provider Demographics
NPI:1730489543
Name:KELLY, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 SPARTAN RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2333
Mailing Address - Country:US
Mailing Address - Phone:301-924-9223
Mailing Address - Fax:301-924-1853
Practice Address - Street 1:3333 SPARTAN RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2333
Practice Address - Country:US
Practice Address - Phone:301-924-9223
Practice Address - Fax:301-924-1853
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist