Kelley Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH00001203 Issued in NM

Legal business name

KELLEY PHARMACY

Practice address

111 W Hobbs St
Roswell, NM 88203-1869

Phone

(505) 622-6000

Fax

(505) 623-8692

NPI assigned

Nov 30, 2006

Organization subpart

No

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

Authorized official

Name

Beau Baumann

Title

Administrator

Phone

(505) 623-3311

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1629145792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882020639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W HOBBS ST",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882031869",
            "telephone_number": "505-622-6000",
            "fax_number": "505-623-8692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "BAUMANN",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "505-623-3311"
    },
    "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": "PH00001203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3200540",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56473",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Jordan
• Marisa Juarez,, AS
• Mose July, MD
• Victoria Arcelia Jurado
• Imad Karam, MD
• Sherry Diane Kelley, R.PH.
• Katrina Nicole Kelly, CNM
• Monica Kelly
• Alyssa Kermode
• Terri Ketner

• Community/Retail Pharmacy in Roswell, NM
• Providers in Roswell, NM by specialty
• Community/Retail Pharmacy in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.