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NPI Code Detail

MEDICARE: SUSAN FAY KIMBALL-ELLIS

MEDICARE: SUSAN FAY KIMBALL-ELLIS
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
1183500000XPharmacistRP033925LPA

General Provider Information

NPI Number : 1740759562
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN FAY KIMBALL-ELLIS
Provider Business Mailing Address
First Line : 1056 WAYNE AVE
Second Line :
City : CHAMBERSBURG
State : PA
Zip : 17201-2924
Country : US
Telephone Number : 717-261-2574
Fax Number : 717-261-2588
Provider Business Practice Location Address
First Line : 1056 WAYNE AVE
Second Line :
City : CHAMBERSBURG
State : PA
Zip : 17201-2924
Country : US
Telephone Number : 717-261-2574
Fax Number : 717-261-2588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2018
Last Update Date : 11/21/2018

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Directions to “ SUSAN FAY KIMBALL-ELLIS ” Practice Location

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