Provider Demographics
NPI:1932843133
Name:GUEVARRA, KELSEY VILLANUEVA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:VILLANUEVA
Last Name:GUEVARRA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 79TH ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4568
Mailing Address - Country:US
Mailing Address - Phone:630-991-1885
Mailing Address - Fax:
Practice Address - Street 1:1000 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2803
Practice Address - Country:US
Practice Address - Phone:630-493-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist