Provider Demographics
NPI:1851651301
Name:KELLEY, ANGELA ANDES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ANDES
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1444
Mailing Address - Country:US
Mailing Address - Phone:864-654-6050
Mailing Address - Fax:864-654-2719
Practice Address - Street 1:525 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1444
Practice Address - Country:US
Practice Address - Phone:864-654-6050
Practice Address - Fax:864-654-2719
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7253183500000X
NC12385183500000X
VA0202009818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist