Provider Demographics
NPI:1174296875
Name:FRAID, KIMBERLY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:FRAID
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:9916 75TH STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7583
Mailing Address - Country:US
Mailing Address - Phone:262-925-0201
Mailing Address - Fax:262-925-8373
Practice Address - Street 1:9916 75TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7583
Practice Address - Country:US
Practice Address - Phone:262-925-0201
Practice Address - Fax:262-925-8373
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1215240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist