Healthcare Provider Details

I. General information

NPI: 1992018188
Provider Name (Legal Business Name): CATHERINE A KELLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 US ROUTE 1
YORK ME
03909-1650
US

IV. Provider business mailing address

400 US ROUTE 1
YORK ME
03909-1650
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-4312
  • Fax: 207-363-4986
Mailing address:
  • Phone: 207-363-4312
  • Fax: 207-363-4986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR3319
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2157
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: