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General NPI Number Information
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NPI Number | 1174705974
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Entity Type | Individual
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Provider Name | DWIGHT KELLEY
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Gender | Male
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 30 LOCUST STREET COOLEY DICKINSON HOSPITAL
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City | NORTHAMPTON
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State | MA
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Zip | 01061-5001
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Country | US
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Telephone | 413-582-2116
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Fax |
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Provider Business Mailing Address
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Address Line | 83 WELLESLEY RD
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City | HOLYOKE
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State | MA
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Zip | 01040-2028
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Country | US
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Telephone | 413-532-1088
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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 | 26889
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License Number State | MA
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