Provider Demographics
NPI:1508370180
Name:KIMBLE, HEATHER Y (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:Y
Last Name:KIMBLE
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 1:1630 N 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3070
Mailing Address - Country:US
Mailing Address - Phone:402-450-4998
Mailing Address - Fax:
Practice Address - Street 1:8700 ANDERMATT DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9653
Practice Address - Country:US
Practice Address - Phone:402-484-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist