Active NPI
Jerry B Kelly, R.PH.
- Geriatric Pharmacist
- Panama City, FL
National Provider Identifier
1881801397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- PS0016008
- Practice address
- 801 E 6TH St
Panama City, FL 32401-3661 - Phone
- (850) 747-6018
- Fax
- (850) 747-6717
- NPI assigned
- May 16, 2007
- 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 |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | PS0016008 | FL | Primary |
Addresses
Primary practice location
801 E 6TH St
Panama City, FL 32401-3661
Mailing address
4333 Northshore Rd
Lynn Haven, FL 32444-4594
Phone (850) 747-6018
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS0016008 | FL | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881801397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4333 NORTHSHORE RD",
"city": "LYNN HAVEN",
"state": "FL",
"postal_code": "324444594",
"telephone_number": "850-747-6018",
"fax_number": "850-747-6717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 E 6TH ST",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324013661",
"telephone_number": "850-747-6018",
"fax_number": "850-747-6717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JERRY",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "FL",
"license": "PS0016008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.