MEDICARE: DR. KIMBERLY ANN KALEC 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	183500000X	Pharmacist	S018112	AZ

General Provider Information

NPI Number	:	1972819514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN KALEC PHARM D

Provider Business Mailing Address
First Line	:	3221 E PRESIDIO RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-6121
Country	:	US
Telephone Number	:	607-738-9843
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 E PRESIDIO RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-6121
Country	:	US
Telephone Number	:	607-738-9843
Fax Number	:

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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