Healthcare Provider Details

I. General information

NPI: 1356931406
Provider Name (Legal Business Name): KELLI JO FORD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 4TH ST E
SOUTH POINT OH
45680-7111
US

IV. Provider business mailing address

PO BOX 416
SOUTH POINT OH
45680-0416
US

V. Phone/Fax

Practice location:
  • Phone: 740-377-2677
  • Fax: 740-377-4554
Mailing address:
  • Phone: 740-377-2677
  • Fax: 740-377-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03223455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: