Provider Demographics
NPI:1316188865
Name:WOODGATE, KIMBERLY DAWN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:WOODGATE
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 1:100 COMMONS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4400
Mailing Address - Country:US
Mailing Address - Phone:512-894-0285
Mailing Address - Fax:
Practice Address - Street 1:100 COMMONS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4400
Practice Address - Country:US
Practice Address - Phone:512-894-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist