Healthcare Provider Details

I. General information

NPI: 1093006041
Provider Name (Legal Business Name): MANDY KLEMICK PHARM,D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 5TH ST
WILLIAMSPORT PA
17701-6201
US

IV. Provider business mailing address

2973 COCHRAN AVE
SOUTH WILLIAMSPORT PA
17702-6710
US

V. Phone/Fax

Practice location:
  • Phone: 570-321-9350
  • Fax: 570-320-9737
Mailing address:
  • Phone: 570-220-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442812
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: