Provider Demographics
NPI:1134439664
Name:CALLIN, KELSEY KEANE (PHARM D)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:KEANE
Last Name:CALLIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MORGAN
Other - Last Name:KEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:73 HAMMOCKS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8706
Mailing Address - Country:US
Mailing Address - Phone:585-507-6272
Mailing Address - Fax:
Practice Address - Street 1:1567 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2331
Practice Address - Country:US
Practice Address - Phone:585-586-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist