Provider Demographics
NPI:1659855229
Name:KERNAN, KELSEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:KERNAN
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 1:29965 SW ROSE LN APT 103
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8809
Mailing Address - Country:US
Mailing Address - Phone:309-230-8144
Mailing Address - Fax:
Practice Address - Street 1:8235 SW WILSONVILLE RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7718
Practice Address - Country:US
Practice Address - Phone:503-682-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist