Provider Demographics
NPI:1215054531
Name:DIEMERT, KELCEY JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:KELCEY
Middle Name:JOHN
Last Name:DIEMERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:96 3RD STREET
Mailing Address - City:CHINOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59523-0609
Mailing Address - Country:US
Mailing Address - Phone:406-357-3333
Mailing Address - Fax:406-357-3336
Practice Address - Street 1:96 3RD STREET
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:MT
Practice Address - Zip Code:59523-0609
Practice Address - Country:US
Practice Address - Phone:406-357-3333
Practice Address - Fax:406-357-3336
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist