MEDICARE: KELLY'S PHARMACY

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	28055	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2135337	OTHER		PK

General Provider Information

NPI Number	:	1881954857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY'S PHARMACY

Provider Business Mailing Address
First Line	:	520 EVERHART RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-1902
Country	:	US
Telephone Number	:	361-334-4500
Fax Number	:	361-334-4504

Provider Business Practice Location Address
First Line	:	520 EVERHART RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-1902
Country	:	US
Telephone Number	:	361-334-4500
Fax Number	:	361-334-4504

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	KELECHI AKPUNKU
Credential	:
Telephone Number	:	361-334-4500

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	09/19/2025

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Directions to “KELLY'S PHARMACY ” Practice Location

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