Provider Demographics
NPI:1285404491
Name:KELLYS PEDIATRIC PHARMACY & COMPOUNDING
Entity type:Organization
Organization Name:KELLYS PEDIATRIC PHARMACY & COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELECHI
Authorized Official - Middle Name:361-855-3811
Authorized Official - Last Name:AKPUNKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-855-3811
Mailing Address - Street 1:3435 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1751
Mailing Address - Country:US
Mailing Address - Phone:361-855-3811
Mailing Address - Fax:361-854-6077
Practice Address - Street 1:3435 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1751
Practice Address - Country:US
Practice Address - Phone:361-855-3811
Practice Address - Fax:361-854-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy