Organization
KELLEY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU BAUMANN (ADMINISTRATOR)
(505) 623-3311
Entity
Organization
Contact information
Practice address
111 W HOBBS ST, ROSWELL, NM 88203-1869
(505) 622-6000
(505) 623-8692
Mailing address
PO BOX 639, ROSWELL, NM 88202-0639
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00001203
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3200540
OTHER ID NUMBER
—
05
—
56473
—
NM
Enumeration date
11/30/2006
Last updated
09/13/2007
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