Provider Demographics
NPI:1649742719
Name:NELSON, KARI KRISTYN (RPH)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:KRISTYN
Last Name:NELSON
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 1:4 JAMES CIR SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-2272
Mailing Address - Country:US
Mailing Address - Phone:218-791-2850
Mailing Address - Fax:
Practice Address - Street 1:2891 2ND AVE N
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6062
Practice Address - Country:US
Practice Address - Phone:701-777-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist