NPIMap

Organization Active NPI

Crlkemper

Doing business as Kelly's Pharmacy

  • Community/Retail Pharmacy
  • Socorro, NM
National Provider Identifier
1245688407
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH00004278 Issued in NM
Legal business name
CRLKEMPER
Doing business as
Kelly's Pharmacy
Practice address
312 N California St
Socorro, NM 87801-4207
Phone
(575) 835-2125
Fax
(575) 835-2026
NPI assigned
May 28, 2016
Last updated
Nov 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Authorized official

Name
Kelly KemperNPI 1477907335
Title
Owner/Ao
Phone
(505) 967-5033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PH00004278 NM Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

312 N California St
Socorro, NM 87801-4207

Mailing address

312 N California St
Socorro, NM 87801-4207
Phone (575) 835-2125

Other identifiers 1

IdentifierTypeStateIssuer
2160348OtherPK

Other names 1

  • Kelly's Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

312 N California St
Socorro, NM 87801
Phone (575) 835-2125

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1464393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478736000000",
    "number": "1245688407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 N CALIFORNIA ST",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014207",
            "telephone_number": "575-835-2125",
            "fax_number": "575-835-2026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 N CALIFORNIA ST",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014207",
            "telephone_number": "575-835-2125",
            "fax_number": "575-835-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRLKEMPER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-28",
        "last_updated": "2016-11-10",
        "status": "A",
        "authorized_official_last_name": "KEMPER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER/AO",
        "authorized_official_telephone_number": "505-967-5033"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NM",
            "license": "PH00004278",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160348",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Socorro, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; 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.