Provider Demographics
NPI:1538497391
Name:STARK, KIMBERLEY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:STARK
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 1:710 N BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2214
Mailing Address - Country:US
Mailing Address - Phone:512-250-0867
Mailing Address - Fax:512-250-5350
Practice Address - Street 1:710 N BELL BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2214
Practice Address - Country:US
Practice Address - Phone:512-250-0867
Practice Address - Fax:512-250-5350
Is Sole Proprietor?:No
Enumeration Date:2009-12-05
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist