Provider Demographics
NPI:1114166162
Name:KIMBALL, DAWN DOMINICA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:DOMINICA
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 SEMINOLE PRATT WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7050 SEMINOLE PRATT WHITNEY RD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3474
Practice Address - Country:US
Practice Address - Phone:561-383-6183
Practice Address - Fax:561-383-6188
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42869183500000X
TN33246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist