Provider Demographics
NPI:1154502094
Name:ARQUETTE, KALSEY D (RPH)
Entity Type:Individual
Prefix:MR
First Name:KALSEY
Middle Name:D
Last Name:ARQUETTE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SEMLOH DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2828
Mailing Address - Country:US
Mailing Address - Phone:315-487-3355
Mailing Address - Fax:
Practice Address - Street 1:5206 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2202
Practice Address - Country:US
Practice Address - Phone:315-468-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471701835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric