Provider Demographics
NPI:1386785053
Name:SELBY, KELLY S (RPH, FIACP)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:S
Last Name:SELBY
Suffix:
Gender:M
Credentials:RPH, FIACP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4400 TEASLEY LN
Mailing Address - Street 2:STE 100
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4650
Mailing Address - Country:US
Mailing Address - Phone:940-382-1618
Mailing Address - Fax:940-898-1986
Practice Address - Street 1:4400 TEASLEY LN
Practice Address - Street 2:STE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-4650
Practice Address - Country:US
Practice Address - Phone:940-382-1618
Practice Address - Fax:940-898-1986
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX25959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist