Healthcare Provider Details

I. General information

NPI: 1285571067
Provider Name (Legal Business Name): DAWN ANN KELLY PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MACCORKLE AVE SE
CHARLESTON WV
25304-1221
US

IV. Provider business mailing address

PO BOX 439
EAST BANK WV
25067-0439
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-0640
  • Fax: 304-351-3110
Mailing address:
  • Phone: 304-388-0640
  • Fax: 304-351-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberPT0004842
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: