=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053727040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ADAM KELLY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2014
-----------------------------------------------------
Last Update Date | 08/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14731 HIGHWAY 231 431 N
-----------------------------------------------------
City | HAZEL GREEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35750-8187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-829-6032
-----------------------------------------------------
Fax | 256-829-6032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 BAYSIDE LN
-----------------------------------------------------
City | TONEY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35773-5730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-452-5999
-----------------------------------------------------
Fax | 256-237-3023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14821
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------