MEDICARE: KELSEY MILLER 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	PH60477417	WA
2	183500000X	Pharmacist	PH.0020550	CO

General Provider Information

NPI Number	:	1780092023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY MILLER PHARMD.

Provider Business Mailing Address
First Line	:	4301 E VIRGINIA AVE
Second Line	:
City	:	GLENDALE
State	:	CO
Zip	:	80246-1510
Country	:	US
Telephone Number	:	303-209-0183
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 E VIRGINIA AVE
Second Line	:
City	:	GLENDALE
State	:	CO
Zip	:	80246-1510
Country	:	US
Telephone Number	:	303-209-0183
Fax Number	:

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	02/14/2022

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