Individual
KEVIN R NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
55 PINE LAKE AVE, LA PORTE, IN 46350-3027
(219) 325-3152
Mailing address
55 PINE LAKE AVE, LA PORTE, IN 46350-3027
(219) 325-3152
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
26024735A
IN
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
26024735A
IN
Other
Enumeration date
08/06/2013
Last updated
01/20/2020
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