Provider Demographics
NPI:1508194705
Name:SEYMOUR, KIMBERLY H (CPHT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12288 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4228
Mailing Address - Country:US
Mailing Address - Phone:754-366-2219
Mailing Address - Fax:
Practice Address - Street 1:1101 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7645
Practice Address - Country:US
Practice Address - Phone:954-421-5358
Practice Address - Fax:954-421-2347
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL470101090265890183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician