Provider Demographics
NPI:1891757357
Name:KELLEY, JAMES L (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-0021
Mailing Address - Country:US
Mailing Address - Phone:870-222-5071
Mailing Address - Fax:870-222-5050
Practice Address - Street 1:104 HOLLY ST
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2249
Practice Address - Country:US
Practice Address - Phone:870-222-5071
Practice Address - Fax:870-222-5050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist