Provider Demographics
NPI:1780286351
Name:ZIEGEMEIER, KELSY (PHARMD)
Entity type:Individual
Prefix:
First Name:KELSY
Middle Name:
Last Name:ZIEGEMEIER
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 1:1302 PARK LN
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-4300
Mailing Address - Country:US
Mailing Address - Phone:636-795-6612
Mailing Address - Fax:
Practice Address - Street 1:1791 SE ENSIGN LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7410
Practice Address - Country:US
Practice Address - Phone:503-861-0146
Practice Address - Fax:503-861-0897
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016030443183500000X
OR0019286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist