Healthcare Provider Details

I. General information

NPI: 1942532510
Provider Name (Legal Business Name): KELLY LYNN FLYNN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WALKER WAY
ALBANY NY
12205-4995
US

IV. Provider business mailing address

30 ROOSEVELT BLVD
COHOES NY
12047-4013
US

V. Phone/Fax

Practice location:
  • Phone: 518-452-7795
  • Fax:
Mailing address:
  • Phone: 518-235-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number039598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: