Provider Demographics
NPI:1881074334
Name:KJELSON, SCOTT (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:KJELSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:KJELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1861 NW SOUTH RIVER DR
Mailing Address - Street 2:804
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2700
Mailing Address - Country:US
Mailing Address - Phone:786-301-1483
Mailing Address - Fax:
Practice Address - Street 1:1861 NW SOUTH RIVER DR
Practice Address - Street 2:804
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2700
Practice Address - Country:US
Practice Address - Phone:786-301-1483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist