Provider Demographics
NPI:1538772827
Name:PODNAR, KELSEY ELAINEA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ELAINEA
Last Name:PODNAR
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 1:1600 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2120
Mailing Address - Country:US
Mailing Address - Phone:618-457-8397
Mailing Address - Fax:618-549-3052
Practice Address - Street 1:1600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2120
Practice Address - Country:US
Practice Address - Phone:618-457-8397
Practice Address - Fax:618-549-3052
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist