Provider Demographics
NPI:1396346649
Name:KELSO, JILL LEA (RPH)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LEA
Last Name:KELSO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 FM 765 W
Mailing Address - Street 2:
Mailing Address - City:PAINT ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:76866-3806
Mailing Address - Country:US
Mailing Address - Phone:325-234-0860
Mailing Address - Fax:325-223-1729
Practice Address - Street 1:5749 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5643
Practice Address - Country:US
Practice Address - Phone:325-223-1426
Practice Address - Fax:325-223-1729
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist