Provider Demographics
NPI:1447853775
Name:HARLAN, KRYSTEN RAEANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:RAEANNE
Last Name:HARLAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1459
Mailing Address - Country:US
Mailing Address - Phone:317-784-9037
Mailing Address - Fax:317-786-2944
Practice Address - Street 1:1715 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1459
Practice Address - Country:US
Practice Address - Phone:317-784-9037
Practice Address - Fax:317-786-2944
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028403A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist