NPIMap

Organization Active NPI

Kelley-Ross and Assoc, Inc.

Doing business as Kelley-Ross Compounding Pharmacy

  • Compounding Pharmacy
  • Seattle, WA
National Provider Identifier
1730500067
Registry record updated Mar 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
PHARCF60434600 Issued in WA
Legal business name
KELLEY-ROSS AND ASSOC, INC.
Doing business as
Kelley-Ross Compounding Pharmacy
Practice address
805 Madison St # 702
Seattle, WA 98104-1172
Phone
(206) 622-3565
NPI assigned
Jan 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2022

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

Authorized official

Name
Ryan Oftebro
Title
President
Phone
(206) 622-3565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X PHARCF60434600 WA Primary

Addresses

Primary practice location

805 Madison St # 702
Seattle, WA 98104-1172

Mailing address

805 Madison St # 702
Seattle, WA 98104-1172
Phone (206) 622-3565

Other identifiers 1

IdentifierTypeStateIssuer
2143617OtherPK

Other names 1

  • Kelley-Ross Compounding Pharmacy Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2102213Kelley-Ross Compounding Pharmacy805 Madison St # 702, Seattle, WA 98104Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Island Prescription Pha6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

805 Madison St
Ste 702
Seattle, WA 98104
Phone (206) 622-3565

NPI Registry JSON

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647129600000",
    "number": "1730500067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST # 702",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-622-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 MADISON ST # 702",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-622-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY-ROSS AND ASSOC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-06",
        "last_updated": "2022-03-13",
        "certification_date": "2022-03-13",
        "status": "A",
        "authorized_official_last_name": "OFTEBRO",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-622-3565"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "WA",
            "license": "PHARCF60434600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143617",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelley-Ross Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.