Provider Demographics
NPI:1063406023
Name:KELSON PHARMACY SERVICES, INC.
Entity type:Organization
Organization Name:KELSON PHARMACY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANSPACH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-324-0234
Mailing Address - Street 1:4957 SW 74TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4471
Mailing Address - Country:US
Mailing Address - Phone:305-324-0234
Mailing Address - Fax:305-324-0744
Practice Address - Street 1:4957 SW 74TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4471
Practice Address - Country:US
Practice Address - Phone:305-324-0234
Practice Address - Fax:305-324-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH18256333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4418270001Medicare ID - Type Unspecified