MEDICARE: MR. KIM A. CALDWELL 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	21170	TX

General Provider Information

NPI Number	:	1568465078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIM A. CALDWELL R.PH.

Provider Business Mailing Address
First Line	:	8016 DAVIDSON DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-2582
Country	:	US
Telephone Number	:	972-517-2851
Fax Number	:	972-517-3841

Provider Business Practice Location Address
First Line	:	8016 DAVIDSON DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-2582
Country	:	US
Telephone Number	:	972-517-2851
Fax Number	:	972-517-3841

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	07/08/2007

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