Provider Demographics
NPI:1285976704
Name:KELLY, NEAL N (RPH)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:N
Last Name:KELLY
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 1:664 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2348
Mailing Address - Country:US
Mailing Address - Phone:503-504-8554
Mailing Address - Fax:360-213-2238
Practice Address - Street 1:664 3RD ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2348
Practice Address - Country:US
Practice Address - Phone:503-504-8554
Practice Address - Fax:360-213-2238
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0012232OtherPHARMACIST LICENSE
ORRPH-0012232-POtherPHARMACY PRECEPTOR LICENSE