Provider Demographics
NPI:1538271168
Name:ENSMINGER, KELLY RAE (RPH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RAE
Last Name:ENSMINGER
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 1:1367 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2316
Mailing Address - Country:US
Mailing Address - Phone:303-885-3019
Mailing Address - Fax:
Practice Address - Street 1:4353 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1115
Practice Address - Country:US
Practice Address - Phone:303-504-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist