Provider Demographics
NPI:1598365280
Name:KESLING, BETH ANN
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:KESLING
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 1:365 ASPEN LN
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-8824
Mailing Address - Country:US
Mailing Address - Phone:317-919-1557
Mailing Address - Fax:574-735-0308
Practice Address - Street 1:240 MALL RD
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2285
Practice Address - Country:US
Practice Address - Phone:574-735-0131
Practice Address - Fax:574-735-0308
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016355A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist