Provider Demographics
NPI:1124691456
Name:CUPP, KELSEY (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:CUPP
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17196 GOOSE HEAVEN RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47327-9704
Mailing Address - Country:US
Mailing Address - Phone:765-541-9765
Mailing Address - Fax:
Practice Address - Street 1:2507 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1105
Practice Address - Country:US
Practice Address - Phone:765-939-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029334A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy