MEDICARE: KELLEY-ROSS & ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	FL00059155	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FL00059155	OTHER	WA	PHARMACY LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154513919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLEY-ROSS & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	2324 EASTLAKE AVE E
Second Line	:	SUITE 400
City	:	SEATTLE
State	:	WA
Zip	:	98102-3345
Country	:	US
Telephone Number	:	206-838-4590
Fax Number	:	206-838-4599

Provider Business Practice Location Address
First Line	:	2324 EASTLAKE AVE E
Second Line	:	SUITE 400
City	:	SEATTLE
State	:	WA
Zip	:	98102-3345
Country	:	US
Telephone Number	:	206-838-4590
Fax Number	:	206-838-4599

Authorized Official
Title or Position	:	TECHNOLOGY DIRECTOR
Name	:	RYAN N HANSEN
Credential	:	PHARMD
Telephone Number	:	206-930-9985

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	10/18/2021

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