Healthcare Provider Details

I. General information

NPI: 1558534651
Provider Name (Legal Business Name): KELSEY KUPIEC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N STATE ROAD 7
MARGATE FL
33063-7002
US

IV. Provider business mailing address

3000 N STATE ROAD 7
MARGATE FL
33063-7002
US

V. Phone/Fax

Practice location:
  • Phone: 954-979-9083
  • Fax:
Mailing address:
  • Phone: 954-979-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: