Active NPI
Kevin Michael Kelly
- Pharmacist
- Greenville, SC
National Provider Identifier
1083255681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42206
- Practice address
- 1211 Woodruff Rd
Greenville, SC 29607-5737 - Phone
- (864) 987-1090
- NPI assigned
- Oct 4, 2019
- Last updated
- Apr 18, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 42206 | SC | Primary |
Addresses
Primary practice location
1211 Woodruff Rd
Greenville, SC 29607-5737
Mailing address
1211 Woodruff Rd
Greenville, SC 29607-5737
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42206 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Publix Pharmacy #2107
- Community/Retail Pharmacy
- Winter Haven, FL
- NPI 1760356380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744934400000",
"number": "1083255681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 WOODRUFF RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296075737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 WOODRUFF RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296075737",
"telephone_number": "864-987-1090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "KEVIN",
"middle_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-04",
"last_updated": "2025-04-18",
"certification_date": "2025-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "42206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.