Provider Demographics
NPI:1245840297
Name:WILSON, KELSEY (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3859
Mailing Address - Country:US
Mailing Address - Phone:330-861-3298
Mailing Address - Fax:
Practice Address - Street 1:1403 WOOSTER RD W
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-7374
Practice Address - Country:US
Practice Address - Phone:330-706-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist