Provider Demographics
NPI:1558654335
Name:WHITE, KIMBERLY RENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RENA
Last Name:WHITE
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 1:3810 DIVINE DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6089
Mailing Address - Country:US
Mailing Address - Phone:540-998-1418
Mailing Address - Fax:
Practice Address - Street 1:901 MEMORIAL DRIVE
Practice Address - Street 2:WALGREENS
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301
Practice Address - Country:US
Practice Address - Phone:540-980-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007253183500000X
VA0202206998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist