Provider Demographics
NPI:1215691571
Name:SEIDEL, KELSEY MARIE (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4816
Mailing Address - Country:US
Mailing Address - Phone:440-352-7051
Mailing Address - Fax:
Practice Address - Street 1:1890 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4816
Practice Address - Country:US
Practice Address - Phone:440-352-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist