Provider Demographics
NPI:1417412420
Name:RICKER, KELSEY GRACE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:GRACE
Last Name:RICKER
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 1:242 LINCOLN WAY W
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6566
Mailing Address - Country:US
Mailing Address - Phone:330-832-4774
Mailing Address - Fax:330-834-1293
Practice Address - Street 1:242 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6566
Practice Address - Country:US
Practice Address - Phone:330-832-4774
Practice Address - Fax:330-834-1293
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist