MEDICARE: JENNIFER STEWART KISTLER PHARM.D.

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	15915	NC

General Provider Information

NPI Number	:	1851652200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER STEWART KISTLER PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 664
Second Line	:
City	:	HILDEBRAN
State	:	NC
Zip	:	28637-0664
Country	:	US
Telephone Number	:	828-397-3420
Fax Number	:	828-397-3477

Provider Business Practice Location Address
First Line	:	300 MAIN AVE W
Second Line	:
City	:	HILDEBRAN
State	:	NC
Zip	:	28637-8315
Country	:	US
Telephone Number	:	828-397-3420
Fax Number	:	828-397-3477

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

Provider Enumeration Date	:	06/01/2012
Last Update Date	:	06/01/2012

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