MEDICARE: DR. KELLY STELL BOBBY PHARM.D.

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	RP439143	PA

General Provider Information

NPI Number	:	1356568224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY STELL BOBBY PHARM.D.

Provider Business Mailing Address
First Line	:	12050 WATERFORD DR
Second Line	:
City	:	IRWIN
State	:	PA
Zip	:	15642-6348
Country	:	US
Telephone Number	:	724-863-4441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1713
Country	:	US
Telephone Number	:	412-672-5576
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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