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NPI Code Detail

MEDICARE: DR. JAMIE LEE RIDLEY KLUCKEN PHARMD

MEDICARE: DR. JAMIE LEE RIDLEY KLUCKEN 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
1183500000XPharmacistP6429ID

General Provider Information

NPI Number : 1811209489
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMIE LEE RIDLEY KLUCKEN PHARMD
Provider Business Mailing Address
First Line : 1428 MOORE PL SW
Second Line :
City : LEESBURG
State : VA
Zip : 20175-5808
Country : US
Telephone Number : 208-329-0653
Fax Number :
Provider Business Practice Location Address
First Line : 45085 UNIVERSITY DR
Second Line :
City : ASHBURN
State : VA
Zip : 20147-2766
Country : US
Telephone Number : 703-726-8547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2010
Last Update Date : 11/19/2014

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