| NPI | 1235504358 |
|---|---|
| Former Name | KELLY MARIE NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122428) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 18193-40) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2022-05-20 |