Healthcare Provider Details

I. General information

NPI: 1881709822
Provider Name (Legal Business Name): KELSEAKER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RODEO RD STE A1
SANTA FE NM
87507-6503
US

IV. Provider business mailing address

2801 RODEO RD STE A1
SANTA FE NM
87507-6503
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-6177
  • Fax: 505-471-3822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP1447
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN GUINN
Title or Position: MEDICAID MEDICARE BILLING SPEC
Credential:
Phone: 314-993-6000