Provider Demographics
NPI:1245903889
Name:WELCH, KELSIE RENEA (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:RENEA
Last Name:WELCH
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-1120
Mailing Address - Country:US
Mailing Address - Phone:318-794-6010
Mailing Address - Fax:
Practice Address - Street 1:1606 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4128
Practice Address - Country:US
Practice Address - Phone:318-626-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.0225841835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care