Provider Demographics
NPI:1932989738
Name:KELLY, PATRICK RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RYAN
Last Name:KELLY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14130 JUANITA DR NE STE 107
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-0127
Mailing Address - Country:US
Mailing Address - Phone:425-823-1000
Mailing Address - Fax:
Practice Address - Street 1:14130 JUANITA DR NE STE 107
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-0127
Practice Address - Country:US
Practice Address - Phone:425-823-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61469197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist