MEDICARE: BETTY JEAN CLYMER 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	5302411331	MI

General Provider Information

NPI Number	:	1669756086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY JEAN CLYMER RPH

Provider Business Mailing Address
First Line	:	992 S MAIN ST
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2265
Country	:	US
Telephone Number	:	231-627-5371
Fax Number	:	231-627-6810

Provider Business Practice Location Address
First Line	:	992 S MAIN ST
Second Line	:
City	:	CHEBOYGAN
State	:	MI
Zip	:	49721-2265
Country	:	US
Telephone Number	:	231-627-5371
Fax Number	:	231-627-6810

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

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/04/2011

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