Individual
ANGELINA AUTIN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
2000 WESTVIEW BLVD, CONROE, TX 77304-3561
(936) 539-9429
Mailing address
8990 STONE OAK DR, MONTGOMERY, TX 77316-6920
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
36402
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36402
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
10/28/2020
Last updated
10/28/2020
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