MEDICARE: DR. KIMBERLY BAUMANN ETHERTON PHARMD, RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2003002135	MO

General Provider Information

NPI Number	:	1306626775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY BAUMANN ETHERTON PHARMD, RPH

Provider Business Mailing Address
First Line	:	817 S MOUNT AUBURN RD STE 130
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6392
Country	:	US
Telephone Number	:	573-519-4550
Fax Number	:	573-519-4590

Provider Business Practice Location Address
First Line	:	817 S MOUNT AUBURN RD STE 130
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6392
Country	:	US
Telephone Number	:	573-519-4550
Fax Number	:	573-519-4590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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