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General NPI Number Information
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NPI Number | 1295863546
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Entity Type | Individual
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Provider Name | TYSON J KETELSEN PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 601 HIGHWAY 6 W
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City | IOWA CITY
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State | IA
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Zip | 52246-2209
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Country | US
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Telephone | 319-338-0581
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Fax | 319-688-3561
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Provider Business Mailing Address
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Address Line | 601 HIGHWAY 6 W
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City | IOWA CITY
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State | IA
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Zip | 52246-2209
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Country | US
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Telephone | 319-338-0581
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Fax | 319-688-3561
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | IA19828
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License Number State | IA
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