Provider Demographics
NPI:1063009322
Name:HARMON, JONATHON KYLE
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:KYLE
Last Name:HARMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1203
Mailing Address - Country:US
Mailing Address - Phone:606-845-2101
Mailing Address - Fax:606-849-2633
Practice Address - Street 1:209 S MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1203
Practice Address - Country:US
Practice Address - Phone:606-845-2101
Practice Address - Fax:606-849-2633
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist