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KELLEY-ROSS PHARMACY AT THE POLYCLINIC
NPI 1669517025
Pharmacy in Seattle, WA

Active since February 21, 2007CLIA 50D2090487 · Waiver
904 7TH AVE, SUITE 103, SEATTLE, WA 98104(206) 324-6990(206) 329-1849 Get Directions Write a Review

NPPES record last updated: January 6, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 6, 2021, Dec 2, 2020, Jan 13, 2020 (3 updates tracked since 2020).

About Kelley-ross Pharmacy At The Polyclinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLEY-ROSS PHARMACY AT THE POLYCLINIC (NPI 1669517025) is a healthcare organization registered as a pharmacy in Seattle, Washington and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Ryan D Oftebro, President, as its authorized official.

NPPES Registry Identity

NPI1669517025
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameKELLEY-ROSS & ASSOC INC
Location Address904 7TH AVE, SUITE 103Seattle, WA 98104-1132
Mailing Address904 7th Ave, Suite 103Seattle, WA 98104-1132 · (206) 324-6990 · Fax (206) 329-1849
Phone(206) 324-6990
Fax(206) 329-1849
Organization SubpartNo
Authorized OfficialRyan D OftebroPresident · (206) 622-3565
Enumeration DateFebruary 21, 2007
Last NPPES UpdateJanuary 6, 20213 updates tracked since enumeration
NPPES CertifiedJanuary 6, 2021
✔ NPI 1669517025 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in WA · CF00055786
Definition

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Also ListedPharmacist · Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy 1835P0018X
Also ListedClinical PharmacologyTaxonomy 208U00000X
Also ListedClinic/CenterTaxonomy 261Q00000X
904 7TH AVE, Seattle, WA 98104
Open in Google Maps ↗

Other Names 1

Doing Business AsKelley-ross Pharmacy At The Polyclinic

Other Identifiers 2

OtherCF00055786WA · State Pharmacy
Medicaid6019087WA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2090487

Kelley-Ross Pharmacy At The Polyclinic · Seattle, WA
Active · expires Apr 4, 2028
CLIA Number50D2090487
Laboratory TypePharmacy
Certificate Effective DateJanuary 23, 2015
Certificate Expiration DateApril 4, 2028
Laboratory DirectorScott Herzog
Laboratory Phone(206) 324-6990
Laboratory LocationKelley-Ross Pharmacy At The Polyclinic904 7th Ave # 103, Seattle, WA 98104
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
302 services301 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
271 services270 patients

Medical Equipment Supplier Medicare DMEPOS 3

Medicare supplier enrollment and the product categories Kelley-Ross Pharmacy carries, from the Medicare DMEPOS supplier directory.

Kelley-Ross Pharmacy

DMEPOS supplier · Seattle, WAOperated by Kelley-Ross & Assoc Inc
⋮

Does not accept Medicare assignment

Kelley-Ross Pharmacy has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20517461
Medicare Participant SinceJanuary 1, 2013
Supplier Location904 7th Ave Ste 103Seattle, WA 98104
Phone(206) 324-6990
Supplier Specialties
Pharmacy

Medicare Product Categories

Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAURA MORRISON MD
Dermatology
904 7TH AVE
SEATTLE, WA 98104
King County (206) 860-4691
DR. JOSEPH W DAVIS M.D.
Internal Medicine
904 7TH AVE
SEATTLE, WA 98104
King County (206) 860-5574
MANDY WARNER MATTA PA-C
Physician Assistant (Surgical)
904 7TH AVE
SEATTLE, WA 98104
King County (206) 329-1760
ANTONIUS MULIA M.D.
Internal Medicine
904 7TH AVE
SEATTLE, WA 98104
King County (206) 329-1760
KATHLEEN MAKIELSKI M.D.
Otolaryngology
904 7TH AVE
SEATTLE, WA 98104
King County (206) 329-1760
DR. XIANGPING REN MD
Physical Medicine & Rehabilitation (Pain Medicine)
904 7TH AVE
SEATTLE, WA 98104
King County (206) 329-1760
ANNA H STEPCZYNSKI M.D.
Internal Medicine
904 7TH AVE
SEATTLE, WA 98104
King County (206) 860-5574
NEHA MITRAGOTRI
Pediatrics
904 7TH AVE
SEATTLE, WA 98104
King County (206) 292-2249

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelley-Ross & Assoc Inc's NPI number?

The NPI number for Kelley-Ross & Assoc Inc is 1669517025. It was assigned to this organization in the NPPES registry on February 21, 2007. The provider is doing business as Kelley-Ross Pharmacy At The Polyclinic.

Where is Kelley-Ross & Assoc Inc located?

Kelley-Ross & Assoc Inc is located at 904 7th Ave Suite 103, Seattle, WA 98104. The listed phone number is (206) 324-6990.

What is Kelley-Ross & Assoc Inc's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Kelley-Ross & Assoc Inc accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Kelley-Ross Pharmacy does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Kelley-Ross & Assoc Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2090487) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kelley-Ross & Assoc Inc accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 50 other insurers list Kelley-Ross & Assoc Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelley-Ross & Assoc Inc was last updated on January 6, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.