Provider Demographics
NPI:1124699640
Name:ERNST, KELSEY GRACE (PHARMD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:GRACE
Last Name:ERNST
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 1:964 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1053
Mailing Address - Country:US
Mailing Address - Phone:269-491-0272
Mailing Address - Fax:
Practice Address - Street 1:345 NAOMI ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1257
Practice Address - Country:US
Practice Address - Phone:269-552-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024134531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist