Provider Demographics
NPI:1558028415
Name:THURSTON, KIMBERLY C (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:THURSTON
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 1:1380 LOCKER RD
Mailing Address - Street 2:
Mailing Address - City:RIMERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16248-8246
Mailing Address - Country:US
Mailing Address - Phone:814-227-9715
Mailing Address - Fax:
Practice Address - Street 1:100 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2130
Practice Address - Country:US
Practice Address - Phone:814-676-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist