MEDICARE: DR. LEVI S VANKIRK 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	183500000X	Pharmacist	3039	WY
2	183500000X	Pharmacist	20715	IA

General Provider Information

NPI Number	:	1609050244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEVI S VANKIRK PHARM.D.

Provider Business Mailing Address
First Line	:	2407 N RIDGE DR
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-1393
Country	:	US
Telephone Number	:	319-541-9223
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 NORTH RIDGE DR
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241
Country	:	US
Telephone Number	:	319-541-9223
Fax Number	:

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

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	06/08/2012

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