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General NPI Number Information
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NPI Number | 1407453863
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Entity Type | Individual
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Provider Name | MAGGIE KRUMWIEDE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 224A E HARRIS AVE
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City | GREENVILLE
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State | IL
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Zip | 62246-2150
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Country | US
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Telephone | 618-690-5000
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Fax | 618-703-1671
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Provider Business Mailing Address
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Address Line | 18 HARVEST PT
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City | COLLINSVILLE
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State | IL
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Zip | 62234-6869
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Country | US
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Telephone | 618-540-8451
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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 | 051.293470
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License Number State | IL
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