MEDICARE: MS. ALETA KEMP 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	051035485	IL

General Provider Information

NPI Number	:	1437422631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALETA KEMP RPH

Provider Business Mailing Address
First Line	:	9628 S EMERALD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-3706
Country	:	US
Telephone Number	:	773-651-2118
Fax Number	:

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

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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