Provider Demographics
NPI:1457652984
Name:HOUSER, KIMBERLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HOUSER
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 1:102 ESPLANDE ST
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-9707
Mailing Address - Country:US
Mailing Address - Phone:518-466-7464
Mailing Address - Fax:
Practice Address - Street 1:461 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-1812
Practice Address - Country:US
Practice Address - Phone:518-379-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI054737-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist