MEDICARE: KIMBERLY AE OHNESORGE 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	18658	IA

General Provider Information

NPI Number	:	1821501321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY AE OHNESORGE PHARMD

Provider Business Mailing Address
First Line	:	1776 W LAKES PKWY STE 100
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8378
Country	:	US
Telephone Number	:	515-241-7569
Fax Number	:	515-241-7536

Provider Business Practice Location Address
First Line	:	1776 W LAKES PKWY STE 100
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8378
Country	:	US
Telephone Number	:	515-241-7569
Fax Number	:	515-241-7536

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

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	11/07/2017

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