Provider Demographics
NPI:1073072005
Name:BLOCK, KIMBERLY JANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112A MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-4400
Mailing Address - Country:US
Mailing Address - Phone:320-468-2072
Mailing Address - Fax:
Practice Address - Street 1:112A MAIN ST S
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-4400
Practice Address - Country:US
Practice Address - Phone:320-468-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist