Provider Demographics
NPI:1316602048
Name:LANFAIR, KELSEY JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JO
Last Name:LANFAIR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JO
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4444 STATE ROAD W 46
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404
Mailing Address - Country:US
Mailing Address - Phone:812-876-2915
Mailing Address - Fax:812-935-8445
Practice Address - Street 1:4444 STATE ROAD W 46
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404
Practice Address - Country:US
Practice Address - Phone:812-876-2915
Practice Address - Fax:812-935-8445
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028803A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist