Provider Demographics
NPI:1851416820
Name:HART, KELLY JARON (PHARMD RPH)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:JARON
Last Name:HART
Suffix:
Gender:M
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 DORCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078
Mailing Address - Country:US
Mailing Address - Phone:701-799-3354
Mailing Address - Fax:
Practice Address - Street 1:420 CENTER AVENUE
Practice Address - Street 2:MOORHEAD DRUG COMPANY
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-233-1529
Practice Address - Fax:218-233-8917
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117693183500000X
ND4713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist