MEDICARE: KIMBERLY NOLTE 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	11170	KS
2	183500000X	Pharmacist	42318	MO

General Provider Information

NPI Number	:	1578566105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY NOLTE RPH

Provider Business Mailing Address
First Line	:	1550 200TH ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-8583
Country	:	US
Telephone Number	:	785-741-3998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 200TH ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-8583
Country	:	US
Telephone Number	:	785-741-3998
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/21/2013

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Directions to “ KIMBERLY NOLTE RPH” Practice Location

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