Provider Demographics
NPI:1366944910
Name:KELLEY, JESSICA RHYAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RHYAN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAWN
Mailing Address - State:SC
Mailing Address - Zip Code:29714-8696
Mailing Address - Country:US
Mailing Address - Phone:423-258-1981
Mailing Address - Fax:
Practice Address - Street 1:1207 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:FORT LAWN
Practice Address - State:SC
Practice Address - Zip Code:29714-8696
Practice Address - Country:US
Practice Address - Phone:423-258-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist