Provider Demographics
NPI:1619453362
Name:MARTINSON, KELSY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELSY
Middle Name:
Last Name:MARTINSON
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:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:MILNOR
Mailing Address - State:ND
Mailing Address - Zip Code:58060-0264
Mailing Address - Country:US
Mailing Address - Phone:701-680-8739
Mailing Address - Fax:
Practice Address - Street 1:330 MAIN ST S
Practice Address - Street 2:
Practice Address - City:FORMAN
Practice Address - State:ND
Practice Address - Zip Code:58032-4001
Practice Address - Country:US
Practice Address - Phone:701-724-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDRPH6048OtherNORTH DAKOTA BOARD OF PHARMACY