Provider Demographics
NPI:1285403386
Name:UPSON, KELLY PATRICIA (RPH, BCNSP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:PATRICIA
Last Name:UPSON
Suffix:
Gender:F
Credentials:RPH, BCNSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7338 REMCON CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1637
Mailing Address - Country:US
Mailing Address - Phone:915-613-5580
Mailing Address - Fax:915-842-0841
Practice Address - Street 1:7338 REMCON CIR STE 300
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1637
Practice Address - Country:US
Practice Address - Phone:915-613-5580
Practice Address - Fax:915-842-0841
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist