Provider Demographics
NPI:1356947022
Name:KELLEY, KERRI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:
Last Name:KELLEY
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 1:501 S MADISON ST STE S
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-2426
Mailing Address - Country:US
Mailing Address - Phone:417-483-5292
Mailing Address - Fax:417-392-6043
Practice Address - Street 1:501 S MADISON ST STE S
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2426
Practice Address - Country:US
Practice Address - Phone:417-483-5292
Practice Address - Fax:417-392-6043
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2010030709183500000X
MO2010030709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist