Provider Demographics
NPI:1477042364
Name:HARM, KRISTIN LEIGH
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:HARM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BIRDIE LN
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-9304
Mailing Address - Country:US
Mailing Address - Phone:308-529-1264
Mailing Address - Fax:
Practice Address - Street 1:200 FRONTIER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-5677
Practice Address - Country:US
Practice Address - Phone:308-324-7437
Practice Address - Fax:308-324-2164
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist