MEDICARE: KELCEY WILSON PHARMD

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	PHCY-05207	NH
2	183500000X	Pharmacist	PHA-PHA-LIC-88451	MT

General Provider Information

NPI Number	:	1396627667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELCEY WILSON PHARMD

Provider Business Mailing Address
First Line	:	82 NEWPORT RD
Second Line	:
City	:	NEW LONDON
State	:	NH
Zip	:	03257-5414
Country	:	US
Telephone Number	:	603-526-2233
Fax Number	:	603-526-2235

Provider Business Practice Location Address
First Line	:	82 NEWPORT RD
Second Line	:
City	:	NEW LONDON
State	:	NH
Zip	:	03257-5414
Country	:	US
Telephone Number	:	603-526-2233
Fax Number	:	603-526-2235

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

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	08/20/2025

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Directions to “ KELCEY WILSON PHARMD” Practice Location

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