Provider Demographics
NPI:1558683581
Name:GOLSAN, KIMBERLY ROBIN (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROBIN
Last Name:GOLSAN
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 1:11256 AUTUMN FARM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8471
Mailing Address - Country:US
Mailing Address - Phone:801-865-1342
Mailing Address - Fax:
Practice Address - Street 1:2040 S 2300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-3220
Practice Address - Country:US
Practice Address - Phone:801-560-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT130827-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist