Provider Demographics
NPI:1326254764
Name:O'CONNOR, KIMBERLY M (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:O'CONNOR
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:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-0259
Mailing Address - Country:US
Mailing Address - Phone:207-337-1456
Mailing Address - Fax:
Practice Address - Street 1:402 GOODRICH AVE
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-438-2582
Practice Address - Fax:401-841-2719
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037993L183500000X
MEPR4886183500000X, 183500000X
NY050588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist