Provider Demographics
NPI:1043735624
Name:SPECIALE, KELSEY LORRAINE (PHARMD, CDCES)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LORRAINE
Last Name:SPECIALE
Suffix:
Gender:F
Credentials:PHARMD, CDCES
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LORRAINE
Other - Last Name:ROYBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1500 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6031
Mailing Address - Country:US
Mailing Address - Phone:520-309-3103
Mailing Address - Fax:
Practice Address - Street 1:1500 W COMMERCE CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6031
Practice Address - Country:US
Practice Address - Phone:520-309-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0226801835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care