Healthcare Provider Details

I. General information

NPI: 1104344621
Provider Name (Legal Business Name): KELSY EDWARD COMBS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 WESTOVER TER
GREENSBORO NC
27408-7128
US

IV. Provider business mailing address

7616 MONTY DR
KERNERSVILLE NC
27284-5004
US

V. Phone/Fax

Practice location:
  • Phone: 336-373-0611
  • Fax:
Mailing address:
  • Phone: 828-406-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number25972
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: