Provider Demographics
NPI:1083218978
Name:KELSOM, COREY SAYURI KAUAI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:SAYURI KAUAI
Last Name:KELSOM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 SPIRIT ST APT 585
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-5119
Mailing Address - Country:US
Mailing Address - Phone:808-271-8616
Mailing Address - Fax:
Practice Address - Street 1:6213 SPIRIT ST APT 585
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-5119
Practice Address - Country:US
Practice Address - Phone:808-271-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist