Provider Demographics
NPI:1386270130
Name:MCMURTRY, KELSEY LYNN (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:LYNN
Last Name:MCMURTRY
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 1:4528 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2740
Mailing Address - Country:US
Mailing Address - Phone:218-624-2820
Mailing Address - Fax:218-624-2870
Practice Address - Street 1:4528 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2740
Practice Address - Country:US
Practice Address - Phone:218-624-2820
Practice Address - Fax:218-624-2870
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist