MEDICARE: DR. MARY ANN KLIETHERMES PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist		IL

General Provider Information

NPI Number	:	1942292768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANN KLIETHERMES PHARM.D.

Provider Business Mailing Address
First Line	:	160 KENMORE AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-3518
Country	:	US
Telephone Number	:	630-833-2067
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-6787
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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