Provider Demographics
NPI:1033756473
Name:KAMINSKI, KIMBERLY B (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:B
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:JANE
Other - Last Name:BASKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 MAGNOLIA LANE
Mailing Address - Street 2:STE A
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-0457
Mailing Address - Country:US
Mailing Address - Phone:706-776-3784
Mailing Address - Fax:706-776-3788
Practice Address - Street 1:130 MAGNOLIA LANE
Practice Address - Street 2:STE A
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-0457
Practice Address - Country:US
Practice Address - Phone:706-776-3784
Practice Address - Fax:706-776-3788
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist