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NPI Code Detail

MEDICARE: DR. KIMBERLY FEDDERLY PHARMD, MS H.N.

MEDICARE: DR. KIMBERLY FEDDERLY PHARMD, MS H.N.
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
1183500000XPharmacist011376KY
21835N1003XNutrition Support Pharmacist4925MT

General Provider Information

NPI Number : 1437575123
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY FEDDERLY PHARMD, MS H.N.
Provider Business Mailing Address
First Line : 103 PONDEROSA LN
Second Line :
City : KALISPELL
State : MT
Zip : 59901-6833
Country : US
Telephone Number : 406-270-7957
Fax Number : 406-755-8432
Provider Business Practice Location Address
First Line : 103 PONDEROSA LN
Second Line :
City : KALISPELL
State : MT
Zip : 59901-6833
Country : US
Telephone Number : 406-270-7957
Fax Number : 406-755-8432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2014
Last Update Date : 03/05/2014

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