Provider Demographics
NPI:1417285602
Name:GOURLEY, KELSEY K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:K
Last Name:GOURLEY
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 1:5115 98TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7530
Mailing Address - Country:US
Mailing Address - Phone:806-698-1354
Mailing Address - Fax:806-698-1136
Practice Address - Street 1:5115 98TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7530
Practice Address - Country:US
Practice Address - Phone:806-698-1354
Practice Address - Fax:806-698-1136
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-26
Last Update Date:2009-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist