Provider Demographics
NPI:1063267391
Name:WHITELAW, KELSEY (PHARMD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WHITELAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-0427
Mailing Address - Country:US
Mailing Address - Phone:870-448-3614
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 427
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-0427
Practice Address - Country:US
Practice Address - Phone:870-448-3614
Practice Address - Fax:870-448-5143
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist