Healthcare Provider Details

I. General information

NPI: 1669517025
Provider Name (Legal Business Name): KELLEY-ROSS & ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 7TH AVE SUITE 103
SEATTLE WA
98104-1132
US

IV. Provider business mailing address

904 7TH AVE SUITE 103
SEATTLE WA
98104-1132
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-6990
  • Fax: 206-329-1849
Mailing address:
  • Phone: 206-324-6990
  • Fax: 206-329-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF00055786
License Number StateWA

VIII. Authorized Official

Name: DR. RYAN D OFTEBRO
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 206-622-3565