Provider Demographics
NPI:1073125332
Name:MORTON, KELSEY R (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:R
Last Name:MORTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:R
Other - Last Name:MILEUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:503 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2203
Mailing Address - Country:US
Mailing Address - Phone:618-565-2329
Mailing Address - Fax:
Practice Address - Street 1:503 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2203
Practice Address - Country:US
Practice Address - Phone:618-565-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist