MEDICARE: DR. KELLI LYNN COOVER PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	10602	NE

General Provider Information

NPI Number	:	1497754626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLI LYNN COOVER PHARM.D.

Provider Business Mailing Address
First Line	:	6715 N 106TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68122-1046
Country	:	US
Telephone Number	:	402-493-4467
Fax Number	:

Provider Business Practice Location Address
First Line	:	7915 N 30TH ST
Second Line	:	7915 N 30 ST
City	:	OMAHA
State	:	NE
Zip	:	68112-2418
Country	:	US
Telephone Number	:	402-827-6080
Fax Number	:	402-827-6085

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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