Provider Demographics
NPI:1497107288
Name:KEMPER, DALE (RPH)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:KEMPER
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 1:312 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
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist