Provider Demographics
NPI:1366433559
Name:KELSEY, KELLY A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:KELSEY
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 1:2780 NORA DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2026
Mailing Address - Country:US
Mailing Address - Phone:801-274-2782
Mailing Address - Fax:
Practice Address - Street 1:257 E 200 S
Practice Address - Street 2:SUITE 600
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2048
Practice Address - Country:US
Practice Address - Phone:801-415-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377087-17011835P1200X
OH03-1-206451835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy