Provider Demographics
NPI:1053648584
Name:RECORD, KELSON DANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELSON
Middle Name:DANIEL
Last Name:RECORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 CHAPEL HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9070
Mailing Address - Country:US
Mailing Address - Phone:801-602-3503
Mailing Address - Fax:
Practice Address - Street 1:1549 GEORGE WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2602
Practice Address - Country:US
Practice Address - Phone:509-946-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60293690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist