MEDICARE: KIMBERLY MACE PHARMD

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	3944	NH

General Provider Information

NPI Number	:	1700204278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MACE PHARMD

Provider Business Mailing Address
First Line	:	1498 WHITE MOUNTAIN HWY
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5183
Country	:	US
Telephone Number	:	603-356-8031
Fax Number	:	603-356-8037

Provider Business Practice Location Address
First Line	:	1498 WHITE MOUNTAIN HWY
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5183
Country	:	US
Telephone Number	:	603-356-8031
Fax Number	:	603-356-8037

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

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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