Provider Demographics
NPI:1730410143
Name:KELLY, MARIE F (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:F
Last Name:KELLY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 SHORELINE DR
Mailing Address - Street 2:UNIT 6404
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-4575
Mailing Address - Country:US
Mailing Address - Phone:727-319-2473
Mailing Address - Fax:
Practice Address - Street 1:8740 PARK BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-4333
Practice Address - Country:US
Practice Address - Phone:727-393-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist