Provider Demographics
NPI:1831496025
Name:KELLEY, THOMAS E (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
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 1:2539 W WHITNER ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-1146
Mailing Address - Country:US
Mailing Address - Phone:864-226-7038
Mailing Address - Fax:864-226-9307
Practice Address - Street 1:2539 W WHITNER ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-1146
Practice Address - Country:US
Practice Address - Phone:864-226-7038
Practice Address - Fax:864-226-9307
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist