Provider Demographics
NPI:1851769160
Name:BOSTWICK, KELSIE FLYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:FLYNN
Last Name:BOSTWICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:WALKER
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2600 NE NEFF RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6337
Mailing Address - Country:US
Mailing Address - Phone:541-706-2608
Mailing Address - Fax:541-706-4806
Practice Address - Street 1:2600 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6337
Practice Address - Country:US
Practice Address - Phone:541-706-2608
Practice Address - Fax:541-706-4806
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00149111835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist