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NPI Code Detail

MEDICARE: KELSEY HARWERTH PHARM. D.

MEDICARE: KELSEY HARWERTH PHARM. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051300574IL
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist051300574IL

General Provider Information

NPI Number : 1609408384
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY HARWERTH PHARM. D.
Provider Business Mailing Address
First Line : 501 N GIANT CITY RD
Second Line :
City : CARBONDALE
State : IL
Zip : 62902-6417
Country : US
Telephone Number : 618-549-9743
Fax Number : 618-549-0683
Provider Business Practice Location Address
First Line : 501 N GIANT CITY RD
Second Line :
City : CARBONDALE
State : IL
Zip : 62902-6417
Country : US
Telephone Number : 618-549-9743
Fax Number : 618-549-0683
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2020
Last Update Date : 02/12/2020

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