Healthcare Provider Details

I. General information

NPI: 1114460821
Provider Name (Legal Business Name): KELSEY KROON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL RD
CROW AGENCY MT
59022
US

IV. Provider business mailing address

1 HOSPITAL RD
CROW AGENCY MT
59022
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3578
  • Fax: 406-638-3326
Mailing address:
  • Phone: 406-638-3578
  • Fax: 406-638-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-39716
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: