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General NPI Number Information
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NPI Number | 1760015630
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Entity Type | Individual
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Provider Name | KELLY LYNN JOLLY RPH
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Gender | Female
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 405 SE ACCESS RD STE A
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City | IOWA PARK
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State | TX
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Zip | 76367-6985
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Country | US
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Telephone | 940-592-2731
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Fax | 940-592-2739
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Provider Business Mailing Address
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Address Line | 5105 LAKE WELLINGTON PKWY
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1771
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Country | US
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Telephone | 940-636-4477
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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 | 30753
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License Number State | TX
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