MEDICARE: KIMBERLY JO WAPP PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20409	IA

General Provider Information

NPI Number	:	1083760367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JO WAPP PHARMD

Provider Business Mailing Address
First Line	:	650 SE WHITETAIL LN
Second Line	:
City	:	WAUKEE
State	:	IA
Zip	:	50263-8549
Country	:	US
Telephone Number	:	515-865-8949
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 UNIVERSITY AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-3533
Country	:	US
Telephone Number	:	515-633-8606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	06/11/2011

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