Provider Demographics
NPI:1306085741
Name:KELLEY, GARRY JAMES (RPH)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:JAMES
Last Name:KELLEY
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 1:224 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3845
Mailing Address - Country:US
Mailing Address - Phone:478-272-1867
Mailing Address - Fax:
Practice Address - Street 1:620 CENTRAL DRIVE
Practice Address - Street 2:
Practice Address - City:EAST DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027
Practice Address - Country:US
Practice Address - Phone:478-272-1867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist