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General NPI Number Information
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NPI Number | 1811149966
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Entity Type | Organization
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Legal Business Name | KELLYS FAMILY PHARMACY
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 704 BRUSHY CREEK RD
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City | EASLEY
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State | SC
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Zip | 29642-2200
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Country | US
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Telephone | 864-343-0540
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Fax | 864-343-0543
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Provider Business Mailing Address
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Address Line | 704 BRUSHY CREEK RD
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City | EASLEY
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State | SC
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Zip | 29642-2200
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Country | US
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Telephone | 864-343-0540
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Fax | 864-343-0543
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Authorized Official
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Title or Position | PIC
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Name | RALPH HUNT
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Credential |
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Telephone | 864-270-1469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10227
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License Number State | SC
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