Provider Demographics
NPI:1790997906
Name:KELLEY, JAMES W (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:KELLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 GOLF CLUB DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8169
Mailing Address - Country:US
Mailing Address - Phone:859-263-9298
Mailing Address - Fax:
Practice Address - Street 1:506 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1306
Practice Address - Country:US
Practice Address - Phone:502-839-5147
Practice Address - Fax:502-839-7155
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist