MEDICARE: MISS KELSEY MADISON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH06006	RI

General Provider Information

NPI Number	:	1093382236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELSEY MADISON PHARMD

Provider Business Mailing Address
First Line	:	206 WALLUM LAKE RD
Second Line	:
City	:	DOUGLAS
State	:	MA
Zip	:	01516-2600
Country	:	US
Telephone Number	:	970-682-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 HIGHLAND CORPORATE DR
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-8703
Country	:	US
Telephone Number	:	800-746-7287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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