MEDICARE: EMILEE KLEMME R.PH

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	26020220A	IN

General Provider Information

NPI Number	:	1225237118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILEE KLEMME R.PH

Provider Business Mailing Address
First Line	:	PO BOX 5545
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47903-5545
Country	:	US
Telephone Number	:	765-448-8000
Fax Number	:	765-448-7695

Provider Business Practice Location Address
First Line	:	2600 GREENBUSH STREET
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47903-2479
Country	:	US
Telephone Number	:	765-448-8000
Fax Number	:	765-448-7695

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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