Active NPI
Elizabeth Kelly, PHARMD
- Pharmacist
- Clearlake, CA
National Provider Identifier
1699119792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 68656
- Practice address
- 15025 Olympic Dr
Clearlake, CA 95422-9526 - Phone
- (707) 994-8677
- NPI assigned
- Apr 19, 2013
- Sex
- Female
- Sole proprietor
- No
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 | 68656 | CA | Primary |
Addresses
Primary practice location
15025 Olympic Dr
Clearlake, CA 95422-9526
Mailing address
401 Bicentennial Way
Santa Rosa, CA 95403-2149
Phone (707) 393-3003
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 |
|---|---|---|---|
| 68656 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrifty Payless Inc | Past | Accepting new patients | |
| Thrifty Payless Inc | 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.
-
- Community/Retail Pharmacy
- Clearlake, CA
- NPI 1093824427
-
- Community/Retail Pharmacy
- Winchester, CA
- NPI 1437874062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641168000000",
"number": "1699119792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 BICENTENNIAL WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954032149",
"telephone_number": "707-393-3003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15025 OLYMPIC DR",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "954229526",
"telephone_number": "707-994-8677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ELIZABETH",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-19",
"last_updated": "2022-01-03",
"certification_date": "2022-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "68656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.