Healthcare Provider Details

I. General information

NPI: 1710713631
Provider Name (Legal Business Name): KELSI FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18495 E QUEEN CREEK RD
QUEEN CREEK AZ
85142-3597
US

IV. Provider business mailing address

18495 E QUEEN CREEK RD
QUEEN CREEK AZ
85142-3597
US

V. Phone/Fax

Practice location:
  • Phone: 480-279-0521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027208
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: