Provider Demographics
NPI:1568209443
Name:KELLY, TROY M (RPH)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:M
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 1:8934 STATE HIGHWAY 34 S
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-9436
Mailing Address - Country:US
Mailing Address - Phone:903-356-6020
Mailing Address - Fax:
Practice Address - Street 1:8934 STATE HIGHWAY 34 S
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-9436
Practice Address - Country:US
Practice Address - Phone:903-356-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11892183500000X
TX35488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist