Provider Demographics
NPI:1730500067
Name:KELLEY-ROSS AND ASSOC, INC.
Entity Type:Organization
Organization Name:KELLEY-ROSS AND ASSOC, INC.
Other - Org Name:KELLEY-ROSS COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OFTEBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-622-3565
Mailing Address - Street 1:805 MADISON ST # 702
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-622-3565
Mailing Address - Fax:
Practice Address - Street 1:805 MADISON ST # 702
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1172
Practice Address - Country:US
Practice Address - Phone:206-622-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHARCF604346003336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143617OtherPK