Healthcare Provider Details

I. General information

NPI: 1881074334
Provider Name (Legal Business Name): SCOTT KJELSON PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SCOTT KJELSON PHARM D.

II. Dates (important events)

Enumeration Date: 05/30/2015
Last Update Date: 05/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 NW SOUTH RIVER DR 804
MIAMI FL
33125-2700
US

IV. Provider business mailing address

1861 NW SOUTH RIVER DR 804
MIAMI FL
33125-2700
US

V. Phone/Fax

Practice location:
  • Phone: 786-301-1483
  • Fax:
Mailing address:
  • Phone: 786-301-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: