Healthcare Provider Details

I. General information

NPI: 1124699640
Provider Name (Legal Business Name): KELSEY GRACE ERNST PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 NAOMI ST
PLAINWELL MI
49080-1257
US

IV. Provider business mailing address

964 MILLER RD
PLAINWELL MI
49080-1053
US

V. Phone/Fax

Practice location:
  • Phone: 269-552-0100
  • Fax:
Mailing address:
  • Phone: 269-491-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302413453
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: