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General NPI Number Information
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NPI Number | 1851416820
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Entity Type | Individual
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Provider Name | KELLY JARON HART PHARMD RPH
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 420 CENTER AVENUE MOORHEAD DRUG COMPANY
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City | MOORHEAD
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State | MN
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Zip | 56560
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Country | US
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Telephone | 218-233-1529
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Fax | 218-233-8917
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Provider Business Mailing Address
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Address Line | 1518 DORCHESTER CT
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City | WEST FARGO
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State | ND
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Zip | 58078
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Country | US
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Telephone | 701-799-3354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 117693
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4713
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License Number State | ND
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