Provider Demographics
NPI:1619328879
Name:MOSHER, KELSEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:MOSHER
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 1:100 MINGES CREEK PL APT A311
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-5781
Mailing Address - Country:US
Mailing Address - Phone:217-821-2190
Mailing Address - Fax:
Practice Address - Street 1:2880 MISSION DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:MI
Practice Address - Zip Code:49344
Practice Address - Country:US
Practice Address - Phone:269-397-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298773183500000X
MI5302043690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist