MEDICARE: MRS. KIMBERLY GEORGE SPEEGLE 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	13849	AL

General Provider Information

NPI Number	:	1790372704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY GEORGE SPEEGLE RPH

Provider Business Mailing Address
First Line	:	236 HAMNER DR
Second Line	:
City	:	LACEYS SPRING
State	:	AL
Zip	:	35754-6206
Country	:	US
Telephone Number	:	256-714-8082
Fax Number	:

Provider Business Practice Location Address
First Line	:	13574 HIGHWAY 231 431 N STE B
Second Line	:
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8642
Country	:	US
Telephone Number	:	256-813-0150
Fax Number	:	256-813-0149

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

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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