Provider Demographics
NPI:1821372434
Name:KELLY, NANCY MARIE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
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 1:1533 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1748
Mailing Address - Country:US
Mailing Address - Phone:724-378-1030
Mailing Address - Fax:
Practice Address - Street 1:4 OLD CLAIRTON RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-3905
Practice Address - Country:US
Practice Address - Phone:412-650-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041125L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist