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General NPI Number Information
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NPI Number | 1003509134
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Entity Type | Individual
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Provider Name | JOHN WALTER KELLY
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Gender | Male
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 120 N BROADWAY
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City | DENVER
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State | CO
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Zip | 80203-3917
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Country | US
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Telephone | 303-722-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 828 N BROADWAY APT 450
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City | DENVER
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State | CO
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Zip | 80203-2789
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Country | US
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Telephone | 317-690-7901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | IN.0002009559
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | IN.0002009559
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License Number State | CO
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