MEDICARE: MS. KIMBERLY NICOLE KLEEMAN 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	RP437730	PA

General Provider Information

NPI Number	:	1174804330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY NICOLE KLEEMAN PHARMD

Provider Business Mailing Address
First Line	:	4098 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2211
Country	:	US
Telephone Number	:	610-876-8815
Fax Number	:	610-876-8868

Provider Business Practice Location Address
First Line	:	4098 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-2211
Country	:	US
Telephone Number	:	610-876-8815
Fax Number	:	610-876-8868

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

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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