MEDICARE: DR. CHRISTINE SPAETH KELSO PHARM.D., BCPS, AE-C

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	2002027584	MO
2	183500000X	Pharmacist	51287985	IL

General Provider Information

NPI Number	:	1629029053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE SPAETH KELSO PHARM.D., BCPS, AE-C

Provider Business Mailing Address
First Line	:	499 S EUCLID AVE
Second Line	:	MAIL STOP # 90-21-342
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	499 S EUCLID AVE
Second Line	:	MAIL STOP # 90-21-342
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1005
Country	:	US
Telephone Number	:	314-362-4812
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/14/2007

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