Provider Demographics
NPI:1558165290
Name:MACDONALD, KELLY (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ATLANTIC AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7025
Mailing Address - Country:US
Mailing Address - Phone:609-441-7088
Mailing Address - Fax:609-441-7089
Practice Address - Street 1:1401 ATLANTIC AVE STE 1000
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7025
Practice Address - Country:US
Practice Address - Phone:609-441-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03500100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist