Provider Demographics
NPI:1093006041
Name:KLEMICK, MANDY (PHARM,D)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:
Last Name:KLEMICK
Suffix:
Gender:F
Credentials:PHARM,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 COCHRAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-6710
Mailing Address - Country:US
Mailing Address - Phone:570-220-4171
Mailing Address - Fax:
Practice Address - Street 1:14 5TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6201
Practice Address - Country:US
Practice Address - Phone:570-321-9350
Practice Address - Fax:570-320-9737
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist