MEDICARE: KELLY ALBRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26019723A	IN

General Provider Information

NPI Number	:	1447914957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ALBRIGHT

Provider Business Mailing Address
First Line	:	8321 W STATE ROAD 56
Second Line	:
City	:	WEST BADEN SPRINGS
State	:	IN
Zip	:	47469-9655
Country	:	US
Telephone Number	:	812-936-7272
Fax Number	:	812-936-7543

Provider Business Practice Location Address
First Line	:	8321 W STATE ROAD 56
Second Line	:
City	:	WEST BADEN SPRINGS
State	:	IN
Zip	:	47469-9655
Country	:	US
Telephone Number	:	812-936-7272
Fax Number	:	812-936-7543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2021
Last Update Date	:	10/30/2021

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