Provider Demographics
NPI:1932235637
Name:KELLEY, KERRY L
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 COVE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3323
Mailing Address - Country:US
Mailing Address - Phone:205-369-1293
Mailing Address - Fax:
Practice Address - Street 1:950 22ND ST N
Practice Address - Street 2:SUITE 590
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1126
Practice Address - Country:US
Practice Address - Phone:205-458-8429
Practice Address - Fax:205-521-7085
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist