Healthcare Provider Details

I. General information

NPI: 1134258890
Provider Name (Legal Business Name): JIM LITMER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ELM STREET
LUDLOW KY
41016-1450
US

IV. Provider business mailing address

3004 MADONNA DRIVE
EDGEWOOD KY
41017-2621
US

V. Phone/Fax

Practice location:
  • Phone: 856-261-2210
  • Fax:
Mailing address:
  • Phone: 859-866-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number06979
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: