Provider Demographics
NPI:1134499064
Name:PALSIS, KIMBERLY DIANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DIANNE
Last Name:PALSIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 W BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-1643
Mailing Address - Country:US
Mailing Address - Phone:813-759-8733
Mailing Address - Fax:813-759-8182
Practice Address - Street 1:2102 W BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1643
Practice Address - Country:US
Practice Address - Phone:813-759-8733
Practice Address - Fax:813-759-8182
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0026308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist