Healthcare Provider Details

I. General information

NPI: 1215054531
Provider Name (Legal Business Name): KELCEY JOHN DIEMERT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 3RD STREET
CHINOOK MT
59523-0609
US

IV. Provider business mailing address

PO BOX 609 96 3RD STREET
CHINOOK MT
59523-0609
US

V. Phone/Fax

Practice location:
  • Phone: 406-357-3333
  • Fax: 406-357-3336
Mailing address:
  • Phone: 406-357-3333
  • Fax: 406-357-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3509
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: