Kelly'S Pharmacy Inc.
Organization Active NPI Community/Retail Pharmacy · Greenville, NY
NPI 1891063012 · NPPES record last updated May 21, 2025
Key facts
- NPI
- 1891063012
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 030985 (NY)
- Legal business name
- KELLY'S PHARMACY INC.
- Practice address
- 4852 State Route 81
Greenville, NY 12083 - Phone
- (518) 966-4800
- Fax
- (518) 966-4950
- NPI assigned
- Dec 2, 2011
- Organization subpart
- No
Authorized official
- Name
- Martin Kelly, BS PHARMACY
- Title
- President
- Phone
- (518) 966-4800
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Practitioners 3
-
Rachel A Raley, PHARMD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kelly'S Pharmacy Inc. |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170830001294 | NY | DME Supplier - Pharmacy | 9739452566 | Practice locations: Greenville, NY |
| O20190130001089 | NY | Part B Supplier - Mass Immunization (Roster Biller Only) | 9739452566 |
2 other NPIs on this enrollment Practice locations: Delmar, NY; Greenville, NY; West Coxsackie, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 030985 | NY | Yes |
Addresses
Primary practice location
4852 State Route 81
Greenville, NY 12083
Mailing address
PO Box 422
Greenville, NY 12083-0422
Phone (518) 966-4800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06305095 | Medicaid | NY | |
| 2132755 | Other | PK |
Other names
- Kelly's Pharmacy Inc.
Other providers in Greenville, NY
- Jennifer E Jones
- Thomas Allen Kearney
- Martin Frederick Kelly
- Quinn Patrick Kelly
- Rebecca Ann Kelly
- Amanda Kistinger
- Brooke Latart
- Geoffrey P Little
- Hui-Hsin Liu
- Debra Ann Macko
All providers in Greenville, NY · Community/Retail Pharmacy in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.