Provider Demographics
NPI:1376766071
Name:BROWN-BLOUNT, KIMBERLY L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:BROWN-BLOUNT
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 1:15905 DOVER CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-6197
Mailing Address - Country:US
Mailing Address - Phone:813-960-2953
Mailing Address - Fax:813-264-7151
Practice Address - Street 1:6800 N DALE MABRY HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3997
Practice Address - Country:US
Practice Address - Phone:813-871-7600
Practice Address - Fax:813-871-4591
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist