Provider Demographics
NPI:1770579526
Name:KELLEY-ROSS & ASSOC INC
Entity type:Organization
Organization Name:KELLEY-ROSS & ASSOC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OFTEBRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:206-622-3565
Mailing Address - Street 1:616 OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1717
Mailing Address - Country:US
Mailing Address - Phone:206-622-3565
Mailing Address - Fax:206-382-9727
Practice Address - Street 1:616 OLIVE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1717
Practice Address - Country:US
Practice Address - Phone:206-622-3565
Practice Address - Fax:206-382-9727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELLEY-ROSS & ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-26
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00001255333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6015308Medicaid
WA0355880004Medicare NSC