MEDICARE: DR. KELSEY GENE SALMON PHARMD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.300366	IL

General Provider Information

NPI Number	:	1346898129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEY GENE SALMON PHARMD, MBA

Provider Business Mailing Address
First Line	:	2628 SANDSTONE DR
Second Line	:
City	:	MARYVILLE
State	:	IL
Zip	:	62062-6453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 BELT LINE RD
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-4368
Country	:	US
Telephone Number	:	618-381-7556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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