Healthcare Provider Details

I. General information

NPI: 1851769160
Provider Name (Legal Business Name): KELSIE FLYNN BOSTWICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSIE WALKER FLYNN PHARMD

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NE NEFF RD
BEND OR
97701-6337
US

IV. Provider business mailing address

2600 NE NEFF RD
BEND OR
97701-6337
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-2608
  • Fax: 541-706-4806
Mailing address:
  • Phone: 541-706-2608
  • Fax: 541-706-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0014911
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: