Healthcare Provider Details

I. General information

NPI: 1467907998
Provider Name (Legal Business Name): KELSEY BRIANNE MOYER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY BRIANNE SIEBOLD PHARMD

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HEATHER HILLS DR
DANVILLE PA
17821-8670
US

IV. Provider business mailing address

136 HEATHER HILLS DR
DANVILLE PA
17821-8670
US

V. Phone/Fax

Practice location:
  • Phone: 440-289-6118
  • Fax:
Mailing address:
  • Phone: 440-289-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449586
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: