MEDICARE: KIMBERLY DEISHER MCGUFFIN CPHT

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	183700000X	Pharmacy Technician	0230002591	VA

General Provider Information

NPI Number	:	1902994221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DEISHER MCGUFFIN CPHT

Provider Business Mailing Address
First Line	:	366 BRIDGE ST N
Second Line	:
City	:	BUCHANAN
State	:	VA
Zip	:	24066-5120
Country	:	US
Telephone Number	:	540-254-1662
Fax Number	:

Provider Business Practice Location Address
First Line	:	19771 MAIN ST
Second Line	:
City	:	BUCHANAN
State	:	VA
Zip	:	24066
Country	:	US
Telephone Number	:	540-254-2904
Fax Number	:	540-254-2907

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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