Provider Demographics
NPI:1053857839
Name:PRESCOTT, KIMBERLI A (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLI
Middle Name:A
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:KIMBERLI
Other - Middle Name:A
Other - Last Name:PRESCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:3301 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3528
Mailing Address - Country:US
Mailing Address - Phone:325-942-0454
Mailing Address - Fax:325-949-9210
Practice Address - Street 1:3301 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3528
Practice Address - Country:US
Practice Address - Phone:325-942-0454
Practice Address - Fax:325-949-9210
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist