Individual
JASON LEE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 WALMART DR, KINGWOOD, WV 26537-1143
(304) 329-4031
Mailing address
55 WEST DR, BRUCETON MILLS, WV 26525-7487
(304) 841-8355
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0007506
WV
Other
Enumeration date
10/14/2019
Last updated
10/14/2019
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