Provider Demographics
NPI:1356816763
Name:HARNED, JON B (RPH)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:B
Last Name:HARNED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 GRAYSON ST
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-2238
Mailing Address - Country:US
Mailing Address - Phone:270-230-0885
Mailing Address - Fax:
Practice Address - Street 1:406 GRAYSON ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2238
Practice Address - Country:US
Practice Address - Phone:270-230-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist