Provider Demographics
NPI:1073025243
Name:KELLY, MARY KATE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY KATE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-1042
Mailing Address - Country:US
Mailing Address - Phone:610-506-8547
Mailing Address - Fax:
Practice Address - Street 1:11 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-6421
Practice Address - Country:US
Practice Address - Phone:610-970-6970
Practice Address - Fax:610-970-6972
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039031L1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care