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General NPI Number Information
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NPI Number | 1295012755
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Entity Type | Individual
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Provider Name | KIMBERLY STANGL PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 11/11/2011
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Last Update Date | 11/11/2011
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Provider Practice Location Address
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Address Line | 1801 PHILO RD
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City | URBANA
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State | IL
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Zip | 61802-6015
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Country | US
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Telephone | 217-367-5486
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 J T COFFMAN DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-4802
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Country | US
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Telephone | 217-722-5393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051291930
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License Number State | IL
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