Brian Thomas Kelley, PHARM.D.
Individual provider Active NPI Pharmacist · Republic, MO
NPI 1770866261 · NPPES record last updated Sep 21, 2011
Key facts
- NPI
- 1770866261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2011027023 (MO)
- Practice address
- 1380 S Appomattox Ave
Republic, MO 65738-7802 - Phone
- (417) 258-0087
- NPI assigned
- Sep 21, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011027023 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2011027023 | MO | Yes |
Addresses
Primary practice location
1380 S Appomattox Ave
Republic, MO 65738-7802
Mailing address
1380 S Appomattox Ave
Republic, MO 65738-7802
Other providers in Republic, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.