Provider Demographics
NPI:1417238627
Name:KELSEY, LARRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:KELSEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:KELSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2021 HIKES LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4817
Mailing Address - Country:US
Mailing Address - Phone:502-451-0931
Mailing Address - Fax:
Practice Address - Street 1:2021 HIKES LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4817
Practice Address - Country:US
Practice Address - Phone:502-451-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist