Active NPI
Robert James Kelly Jr., PHARM D
- Pharmacist
- San Antonio, TX
National Provider Identifier
1407139504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 49256
- Practice address
- 1105 Goliad Rd
San Antonio, TX 78223-1838 - Phone
- (210) 533-7602
- NPI assigned
- Sep 25, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 49256 | TX | Primary |
Addresses
Primary practice location
1105 Goliad Rd
San Antonio, TX 78223-1838
Mailing address
1105 Goliad Rd
San Antonio, TX 78223-1838
Phone (210) 533-7602
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
| License | State | Type | Specialty |
|---|---|---|---|
| 49256 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316908800000",
"number": "1407139504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 GOLIAD RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782231838",
"telephone_number": "210-533-7602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 GOLIAD RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782231838",
"telephone_number": "210-533-7602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ROBERT",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-25",
"last_updated": "2011-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "49256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.