MEDICARE: JILL MARIE KRUPP 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	021573	KY

General Provider Information

NPI Number	:	1205587912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MARIE KRUPP PHARMD

Provider Business Mailing Address
First Line	:	119 VERDANT TRL
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8210
Country	:	US
Telephone Number	:	859-533-7466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1283 US HIGHWAY 27 N
Second Line	:
City	:	STANFORD
State	:	KY
Zip	:	40484-9750
Country	:	US
Telephone Number	:	606-365-2153
Fax Number	:

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

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	01/13/2022

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