Provider Demographics
NPI:1073532438
Name:WILSON, KIM YVETTE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:YVETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 PALERMO CIR
Mailing Address - Street 2:APARTMENT 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5080
Mailing Address - Country:US
Mailing Address - Phone:813-620-3765
Mailing Address - Fax:813-620-3765
Practice Address - Street 1:3800 FLETCHER AVE
Practice Address - Street 2:SUITE 133
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-975-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-01-24593183500000X
FLPS 455521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist