Organization
CRLKEMPER
Active
Other names
Kelly's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY KEMPER (OWNER/AO)
(505) 967-5033
Entity
Organization
Contact information
Practice address
312 N CALIFORNIA ST, SOCORRO, NM 87801-4207
(575) 835-2125
(575) 835-2026
Mailing address
312 N CALIFORNIA ST, SOCORRO, NM 87801-4207
(575) 835-2125
(575) 835-2026
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00004278
NM
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160348
PK
—
Enumeration date
05/28/2016
Last updated
11/10/2016
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