Provider Demographics
NPI:1376765172
Name:HULST, KELLY KAY (RPH)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:KAY
Last Name:HULST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:ND
Mailing Address - Zip Code:58278-9330
Mailing Address - Country:US
Mailing Address - Phone:701-599-2491
Mailing Address - Fax:701-780-6577
Practice Address - Street 1:1000 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4032
Practice Address - Country:US
Practice Address - Phone:701-772-4875
Practice Address - Fax:701-780-6577
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist