Provider Demographics
NPI:1851749527
Name:KELLETT, JOSHUA ROSS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ROSS
Last Name:KELLETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4330
Mailing Address - Country:US
Mailing Address - Phone:501-279-1125
Mailing Address - Fax:
Practice Address - Street 1:200 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4330
Practice Address - Country:US
Practice Address - Phone:501-279-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist