Healthcare Provider Details

I. General information

NPI: 1477688463
Provider Name (Legal Business Name): J&B KELLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH LIVERMORE
HAZEN AR
72064-0507
US

IV. Provider business mailing address

PO BOX 507
HAZEN AR
72064-0507
US

V. Phone/Fax

Practice location:
  • Phone: 870-255-4403
  • Fax: 870-255-3772
Mailing address:
  • Phone: 870-255-4403
  • Fax: 870-255-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7514
License Number StateAR

VIII. Authorized Official

Name: MR. JOSEPH BYRUM KELLY
Title or Position: PRESIDENT
Credential:
Phone: 870-255-4403