Provider Demographics
NPI:1104421676
Name:PROSINSKI, KELSEY (PHARMD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PROSINSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:PROSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 VESTAL PKWY W
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1549
Mailing Address - Country:US
Mailing Address - Phone:607-748-7421
Mailing Address - Fax:
Practice Address - Street 1:138 VESTAL PKWY W
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1549
Practice Address - Country:US
Practice Address - Phone:607-748-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist