Provider Demographics
NPI:1417402348
Name:GARNTO, KELSI SIERRA
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:SIERRA
Last Name:GARNTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 S MARCUS ST
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-5803
Mailing Address - Country:US
Mailing Address - Phone:478-290-2247
Mailing Address - Fax:
Practice Address - Street 1:620 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:EAST DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-7414
Practice Address - Country:US
Practice Address - Phone:478-272-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist