Provider Demographics
NPI:1992733679
Name:KRAMER, KIM EDWIN (RPH)
Entity type:Individual
Prefix:MR
First Name:KIM
Middle Name:EDWIN
Last Name:KRAMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-1021
Mailing Address - Country:US
Mailing Address - Phone:712-464-7429
Mailing Address - Fax:
Practice Address - Street 1:507 E LAKE ST
Practice Address - Street 2:
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579-1711
Practice Address - Country:US
Practice Address - Phone:712-297-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist