Organization
KELSEAKER LTD
Active
Other names
MEDICAP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN GUINN (MEDICAID MEDICARE BILLING SPEC)
(314) 993-6000
Entity
Organization
Contact information
Practice address
2801 RODEO RD STE A1, SANTA FE, NM 87507-6503
(505) 471-6177
(505) 471-3822
Mailing address
2801 RODEO RD STE A1, SANTA FE, NM 87507-6503
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
P1447
NM
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3207974
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
65706
—
NM
Enumeration date
08/20/2006
Last updated
09/11/2025
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