Provider Demographics
NPI:1285055814
Name:MCADAMS, KELLY MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:MICHAEL
Last Name:MCADAMS
Suffix:
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 1:5155 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-3002
Mailing Address - Country:US
Mailing Address - Phone:812-584-6656
Mailing Address - Fax:
Practice Address - Street 1:5155 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-3002
Practice Address - Country:US
Practice Address - Phone:812-584-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016152A183500000X
KY010346183500000X
OH03119201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist