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General NPI Number Information
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NPI Number | 1063936664
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Entity Type | Individual
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Provider Name | KELSEY BINGHAM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 315 N 193RD EAST AVE
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City | CATOOSA
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State | OK
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Zip | 74015-2862
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Country | US
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Telephone | 918-266-8837
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Fax | 918-266-1512
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Provider Business Mailing Address
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Address Line | 6509 S 93RD EAST AVE APT D
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City | TULSA
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State | OK
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Zip | 74133-1451
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Country | US
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Telephone | 816-206-0567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1-17080
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2015026125
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16299
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License Number State | OK
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