Provider Demographics
NPI:1609408384
Name:HARWERTH, KELSEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HARWERTH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:BIRKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 N GIANT CITY RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-6417
Mailing Address - Country:US
Mailing Address - Phone:618-549-9743
Mailing Address - Fax:618-549-0683
Practice Address - Street 1:501 N GIANT CITY RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-6417
Practice Address - Country:US
Practice Address - Phone:618-549-9743
Practice Address - Fax:618-549-0683
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300574183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist