Organization
STANDARD PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES EDWARD KELLY SR. RPH (OWNER AND RPH)
(937) 325-2224
Entity
Organization
Contact information
Practice address
541 W MAIN ST, SPRINGFIELD, OH 45504
(937) 325-2224
(937) 325-0422
Mailing address
541 W MAIN ST, SPRINGFIELD, OH 45504
(937) 325-2224
(937) 325-0422
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
02009935002049
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8371953
—
OH
Enumeration date
04/04/2007
Last updated
07/30/2008
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