Healthcare Provider Details

I. General information

NPI: 1841179348
Provider Name (Legal Business Name): KELLY HONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MELNEA CASS BLVD
ROXBURY MA
02119-4401
US

IV. Provider business mailing address

11 MELNEA CASS BLVD
ROXBURY MA
02119-4401
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-2080
  • Fax:
Mailing address:
  • Phone: 617-414-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number070686
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH1000635
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: