Individual ProviderKimberly TetraultPharmacistPharmacy Service ProvidersPractice Address1500 Forest Glen Rd, Silver Spring, MD 20910-1483(301) 754-7126(765) 748-1213PECOS EnrollmentBased on the most recent information from CMS, provider Kimberly Tetrault does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1932316783Provider TypeIndividualFull NameTetrault, KimberlyGenderFemaleSole ProprietorNoEnumeration Date5/17/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address1500 Forest Glen Rd, Silver Spring, MD 20910-1483Phone(301) 754-7126Fax(301) 754-7127Mailing LocationMailing Address5480 Wisconsin Ave Apt 916, Chevy Chase, MD 20815-3513Phone(765) 748-1213FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense17763Maryland