Provider Demographics
NPI:1114134285
Name:KELLY, JAMES CLIFTON III (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CLIFTON
Last Name:KELLY
Suffix:III
Gender:M
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:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-0327
Mailing Address - Country:US
Mailing Address - Phone:601-765-6817
Mailing Address - Fax:
Practice Address - Street 1:204 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-0327
Practice Address - Country:US
Practice Address - Phone:601-765-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist