Kelly Leann Rio, PHARM.D. – Pharmacist

Key facts

NPI: 1104897982
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: P6230 (ID)
Practice address: 1101 26TH Ave S
Great Falls, MT 59405-5161
Phone: (406) 455-5430
NPI assigned: Jan 30, 2006
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Pharmacy

State licenses

License	State	Type	Specialty
P6230	ID	MD	Pharmacist
PH00050019	WA	MD	Pharmacist
4563	MT	MD	Internal Medicine Physician

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	4563	MT
Pharmacist	183500000X	PH00050019	WA
Pharmacist	183500000X	P6230	ID	Yes

Addresses

Primary practice location

1101 26TH Ave S
Great Falls, MT 59405-5161

Mailing address

1101 26TH Ave S
Great Falls, MT 59405-5161
Phone (406) 455-5430

Other names

Kelly Leann Peterson Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 24, 2020.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1104897982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 26TH AVE S",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594055161",
            "telephone_number": "406-455-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 26TH AVE S",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594055161",
            "telephone_number": "406-455-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIO",
        "first_name": "KELLY",
        "middle_name": "LEANN",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MT",
            "license": "4563",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00050019",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P6230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "PETERSON",
            "middle_name": "LEANN",
            "credential": "PHARM.D., BCOP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Great Falls, MT

All providers in Great Falls, MT · Pharmacist in Montana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.