Provider Demographics
NPI:1932771524
Name:GROVES, KELSEY NOEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:NOEL
Last Name:GROVES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:NOEL
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 W GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4415
Practice Address - Country:US
Practice Address - Phone:870-881-8434
Practice Address - Fax:870-881-8448
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist