Provider Demographics
NPI:1477829679
Name:DO, KIMBERLI JEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:JEN
Last Name:DO
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 1:4306 COMET CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8044
Mailing Address - Country:US
Mailing Address - Phone:407-334-4687
Mailing Address - Fax:
Practice Address - Street 1:2250 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1443
Practice Address - Country:US
Practice Address - Phone:407-303-7572
Practice Address - Fax:407-303-9375
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL219727OtherNABP