Provider Demographics
NPI:1053727040
Name:KELLY, DAVID ADAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ADAM
Last Name:KELLY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STANFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-8124
Mailing Address - Country:US
Mailing Address - Phone:256-452-5999
Mailing Address - Fax:256-237-3023
Practice Address - Street 1:1401 S QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-8248
Practice Address - Country:US
Practice Address - Phone:256-237-0759
Practice Address - Fax:256-237-3023
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist