Provider Demographics
NPI:1013215227
Name:DUCKWORTH, KIMBERLY P (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:P
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:G
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3491 STALLINGS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9410
Mailing Address - Country:US
Mailing Address - Phone:706-863-2113
Mailing Address - Fax:706-869-0014
Practice Address - Street 1:377 FURYS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-3047
Practice Address - Country:US
Practice Address - Phone:706-854-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist