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General NPI Number Information
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NPI Number | 1356947022
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Entity Type | Individual
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Provider Name | KERRI KELLEY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 501 S MADISON ST STE S
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City | WEBB CITY
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State | MO
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Zip | 64870-2426
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Country | US
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Telephone | 417-483-5292
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Fax | 417-392-6043
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Provider Business Mailing Address
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Address Line | 501 S MADISON ST STE S
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City | WEBB CITY
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State | MO
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Zip | 64870-2426
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Country | US
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Telephone | 417-483-5292
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Fax | 417-392-6043
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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 | 2010030709
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2010030709
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License Number State | MO
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