Provider Demographics
NPI:1215213715
Name:RIDILLA, KIMBERLY SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:RIDILLA
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 1:129 RIDILLA LAKES LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7739
Mailing Address - Country:US
Mailing Address - Phone:724-834-6973
Mailing Address - Fax:
Practice Address - Street 1:4000 HEMPFIELD PLAZA BLVD
Practice Address - Street 2:SUITE 966
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1483
Practice Address - Country:US
Practice Address - Phone:724-836-8412
Practice Address - Fax:800-831-7979
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP04176OL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist