MEDICARE: DR. MICHAEL P KELSCH PHARM.D., BCPS

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	1835P1200X	Pharmacotherapy Pharmacist	4763	ND

General Provider Information

NPI Number	:	1477700748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P KELSCH PHARM.D., BCPS

Provider Business Mailing Address
First Line	:	118G SUDRO HALL
Second Line	:	NORTH DAKOTA STATE UNIVERSITY
City	:	FARGO
State	:	ND
Zip	:	58105-5055
Country	:	US
Telephone Number	:	701-231-6528
Fax Number	:	701-231-7606

Provider Business Practice Location Address
First Line	:	118G SUDRO HALL
Second Line	:	NORTH DAKOTA STATE UNIVERSITY
City	:	FARGO
State	:	ND
Zip	:	58105-5055
Country	:	US
Telephone Number	:	701-231-6528
Fax Number	:	701-231-7606

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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