Provider Demographics
NPI:1447733324
Name:GOCKE, KELSEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:GOCKE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0569
Mailing Address - Country:US
Mailing Address - Phone:870-297-8107
Mailing Address - Fax:870-297-8799
Practice Address - Street 1:526 PARK ST
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-9070
Practice Address - Country:US
Practice Address - Phone:870-297-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist