MEDICARE: SHANNON ALLISON KELLY PHARMD

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	183500000X	Pharmacist	PH60671456	WA
2	183500000X	Pharmacist	RPH-0014927	OR

General Provider Information

NPI Number	:	1194172668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ALLISON KELLY PHARMD

Provider Business Mailing Address
First Line	:	380 SW 194TH CT
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97006-1942
Country	:	US
Telephone Number	:	203-907-6869
Fax Number	:

Provider Business Practice Location Address
First Line	:	8329 SW BEAVERTON HILLSDALE HWY BLDG 2
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-2215
Country	:	US
Telephone Number	:	503-414-5172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2016
Last Update Date	:	09/27/2023

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Directions to “ SHANNON ALLISON KELLY PHARMD” Practice Location

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