Healthcare Provider Details

I. General information

NPI: 1154513919
Provider Name (Legal Business Name): KELLEY-ROSS & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 EASTLAKE AVE E SUITE 400
SEATTLE WA
98102-3345
US

IV. Provider business mailing address

2324 EASTLAKE AVE E SUITE 400
SEATTLE WA
98102-3345
US

V. Phone/Fax

Practice location:
  • Phone: 206-838-4590
  • Fax: 206-838-4599
Mailing address:
  • Phone: 206-838-4590
  • Fax: 206-838-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberFL00059155
License Number StateWA

VIII. Authorized Official

Name: RYAN N HANSEN
Title or Position: TECHNOLOGY DIRECTOR
Credential: PHARMD
Phone: 206-930-9985