Healthcare Provider Details

I. General information

NPI: 1992733679
Provider Name (Legal Business Name): KIM EDWIN KRAMER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E LAKE ST
ROCKWELL CITY IA
50579-1711
US

IV. Provider business mailing address

800 W MADISON ST
LAKE CITY IA
51449-1021
US

V. Phone/Fax

Practice location:
  • Phone: 712-297-7337
  • Fax:
Mailing address:
  • Phone: 712-464-7429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14560
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: