Provider Demographics
NPI:1477030096
Name:SPIRE, KELSEY MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:SPIRE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:HARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2216
Mailing Address - Country:US
Mailing Address - Phone:174-820-3577
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 140
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2216
Practice Address - Country:US
Practice Address - Phone:417-820-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14620183500000X
MO2019001464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist