Healthcare Provider Details

I. General information

NPI: 1619328879
Provider Name (Legal Business Name): KELSEY MOSHER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 MISSION DR
SHELBYVILLE MI
49344
US

IV. Provider business mailing address

100 MINGES CREEK PL APT A311
BATTLE CREEK MI
49015-5781
US

V. Phone/Fax

Practice location:
  • Phone: 269-397-1760
  • Fax:
Mailing address:
  • Phone: 217-821-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051298773
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302043690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: