MEDICARE: MRS. KELLI LYNN RINIKER RPH

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	22463	IA

General Provider Information

NPI Number	:	1417585217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLI LYNN RINIKER RPH

Provider Business Mailing Address
First Line	:	2026 CEDAR HILL AVE SE
Second Line	:
City	:	DYERSVILLE
State	:	IA
Zip	:	52040-7602
Country	:	US
Telephone Number	:	608-628-1602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 W MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	IA
Zip	:	52057-2305
Country	:	US
Telephone Number	:	563-927-3377
Fax Number	:

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

Provider Enumeration Date	:	03/29/2020
Last Update Date	:	03/29/2020

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