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NPI Code Detail

MEDICARE: MR. LARRY KELSEY RPH

MEDICARE: MR. LARRY KELSEY RPH
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
1183500000XPharmacist007466KY

General Provider Information

NPI Number : 1417238627
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY KELSEY RPH
Provider Business Mailing Address
First Line : 2021 HIKES LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-4817
Country : US
Telephone Number : 502-451-0931
Fax Number :
Provider Business Practice Location Address
First Line : 2021 HIKES LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-4817
Country : US
Telephone Number : 502-451-0931
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 09/01/2011

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Directions to “ MR. LARRY KELSEY RPH” Practice Location

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