Provider Demographics
NPI:1942642160
Name:MACEDO, KELLY A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:MACEDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:CABRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:861 LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02715-1157
Mailing Address - Country:US
Mailing Address - Phone:508-642-5171
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234721183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist