Healthcare Provider Details

I. General information

NPI: 1023453438
Provider Name (Legal Business Name): KELLY CARSTENS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 W 75TH DR
ARVADA CO
80005-5324
US

IV. Provider business mailing address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-5402
  • Fax:
Mailing address:
  • Phone: 303-689-4000
  • Fax: 303-689-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11479
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: