Provider Demographics
NPI:1366788366
Name:KELDSEN, CHRISTINE ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:KELDSEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8429 CABIN CREEK DR APT E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6327
Mailing Address - Country:US
Mailing Address - Phone:307-371-8788
Mailing Address - Fax:
Practice Address - Street 1:4850 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3321
Practice Address - Country:US
Practice Address - Phone:317-787-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024714A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist