Provider Demographics
NPI:1538702584
Name:WILSON, KIMBERLY S (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:WILSON
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 1:1493 GROUNDSEL LN
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5705
Mailing Address - Country:US
Mailing Address - Phone:850-443-8281
Mailing Address - Fax:
Practice Address - Street 1:9600 PARKSOUTH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6424
Practice Address - Country:US
Practice Address - Phone:407-294-7176
Practice Address - Fax:407-294-7879
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist