Provider Demographics
NPI:1407453863
Name:KRUMWIEDE, MAGGIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:KRUMWIEDE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HARVEST PT
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6869
Mailing Address - Country:US
Mailing Address - Phone:618-540-8451
Mailing Address - Fax:
Practice Address - Street 1:224A E HARRIS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2150
Practice Address - Country:US
Practice Address - Phone:618-690-5000
Practice Address - Fax:618-703-1671
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist