Provider Demographics
NPI:1922623784
Name:DICKINSON, KELSEY FAYE (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:FAYE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7687 HALLEYS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-8921
Mailing Address - Country:US
Mailing Address - Phone:303-718-7076
Mailing Address - Fax:
Practice Address - Street 1:7687 HALLEYS DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-8921
Practice Address - Country:US
Practice Address - Phone:303-718-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3037187076Medicaid