Provider Demographics
NPI:1235670332
Name:KIMBROUGH-WATERS, KEIRA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KEIRA
Middle Name:
Last Name:KIMBROUGH-WATERS
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 1:1537 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3764
Mailing Address - Country:US
Mailing Address - Phone:706-731-1341
Mailing Address - Fax:
Practice Address - Street 1:1537 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3764
Practice Address - Country:US
Practice Address - Phone:706-731-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist