Provider Demographics
NPI:1083760367
Name:WAPP, KIMBERLY JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:WAPP
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 1:650 SE WHITETAIL LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8549
Mailing Address - Country:US
Mailing Address - Phone:515-865-8949
Mailing Address - Fax:
Practice Address - Street 1:4100 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3533
Practice Address - Country:US
Practice Address - Phone:515-633-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist