Provider Demographics
NPI:1760730972
Name:KELSEY, JOHN P III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:KELSEY
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8553
Mailing Address - Country:US
Mailing Address - Phone:901-246-5399
Mailing Address - Fax:
Practice Address - Street 1:127 CRESTVIEW PL STE 100
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1067
Practice Address - Country:US
Practice Address - Phone:615-446-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist