Provider Demographics
NPI:1346936408
Name:FLORY, KIMBERLY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:FLORY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:CHUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:11592 STONECREEK CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9084
Mailing Address - Country:US
Mailing Address - Phone:615-482-7762
Mailing Address - Fax:
Practice Address - Street 1:3677 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8226
Practice Address - Country:US
Practice Address - Phone:239-243-9025
Practice Address - Fax:877-270-9723
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist