NPIMap

Individual provider Active NPI

Kelly Anne Wales, PHARM.D.

  • Pharmacist
  • Winston Salem, NC
National Provider Identifier
1124648126
Registry record updated Apr 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
18163 Issued in NC
Practice address
3917-A Westpoint Boulevard
Winston-Salem, NC 27103
Phone
(336) 773-1013
NPI assigned
Apr 20, 2020
Last updated
Apr 20, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0202205435 VA
Pharmacist 183500000X 13058 SC
Pharmacist 183500000X 18163 NC Primary

Addresses

Primary practice location

3917-A Westpoint Boulevard
Winston-Salem, NC 27103

Mailing address

409 Chesham Drive
Kernersville, NC 27284
Phone (336) 202-7766

Other names 1

  • Kelly Anne Wales Jurek Former name

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
18163NCMDPharmacist
0202205435VAMDPharmacist
13058SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Medipack Pharmacy Operator LLC CurrentSince Jun 23, 2024 Accepting new patients
Medipack Pharmacy LLC PastSince Apr 26, 2020 Accepting new patients

Locations

3917 Westpoint Blvd
Ste A
Winston Salem, NC 27103
Phone (336) 773-1013

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1124648126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 CHESHAM DRIVE",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "27284",
            "telephone_number": "336-202-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3917-A WESTPOINT BOULEVARD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-773-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALES",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202205435",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "13058",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "18163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY ANNE",
            "last_name": "JUREK",
            "middle_name": "WALES",
            "credential": "PHARM.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.