Healthcare Provider Details

I. General information

NPI: 1598595936
Provider Name (Legal Business Name): KELSIE HUTSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 N HIGHWAY 67
FLORISSANT MO
63033-1605
US

IV. Provider business mailing address

752 CASTLE RIDGE DR
BALLWIN MO
63021-4476
US

V. Phone/Fax

Practice location:
  • Phone: 314-824-0022
  • Fax:
Mailing address:
  • Phone: 636-577-9372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024030009
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: