Healthcare Provider Details

I. General information

NPI: 1841268950
Provider Name (Legal Business Name): MARY STURGELESKI KELLY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 3RD AVE SOUTH
SEATTLE WA
98104
US

IV. Provider business mailing address

6754 27TH AVE NW
SEATTLE WA
98117
US

V. Phone/Fax

Practice location:
  • Phone: 206-521-1762
  • Fax: 206-521-1750
Mailing address:
  • Phone: 206-782-0261
  • Fax: 206-782-0261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00042346
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number60007146
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: