Provider Demographics
NPI:1811347594
Name:CRLKEMPER
Entity type:Organization
Organization Name:CRLKEMPER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-967-5033
Mailing Address - Street 1:312 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4207
Mailing Address - Country:US
Mailing Address - Phone:575-835-2125
Mailing Address - Fax:575-835-2026
Practice Address - Street 1:312 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4207
Practice Address - Country:US
Practice Address - Phone:575-835-2125
Practice Address - Fax:575-835-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty