Provider Demographics
NPI:1992303549
Name:LEER, KELSEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:LEER
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 1:201 RITCHIE RD APT 437
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-4311
Mailing Address - Country:US
Mailing Address - Phone:979-203-0556
Mailing Address - Fax:
Practice Address - Street 1:1201 ELLEN TROUT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1233
Practice Address - Country:US
Practice Address - Phone:936-634-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist