Provider Demographics
NPI:1174800502
Name:WILSON, KELSEY B (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:B
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KELSEY
Other - Middle Name:B
Other - Last Name:SIMUNEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1925 W OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5528
Mailing Address - Country:US
Mailing Address - Phone:580-242-3715
Mailing Address - Fax:580-237-4199
Practice Address - Street 1:1925 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5528
Practice Address - Country:US
Practice Address - Phone:580-242-3784
Practice Address - Fax:580-237-4199
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist