Provider Demographics
NPI:1598973240
Name:NELSON, K.C. (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:K.C.
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KENT
Other - Middle Name:CHRISTOPHER
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:721 18TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1454
Mailing Address - Country:US
Mailing Address - Phone:605-262-0444
Mailing Address - Fax:
Practice Address - Street 1:3820 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6638
Practice Address - Country:US
Practice Address - Phone:605-229-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR5434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist