Provider Demographics
NPI:1568702538
Name:FERITTA, KIMBERLY R (PHARM D)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:FERITTA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1841
Mailing Address - Country:US
Mailing Address - Phone:210-602-7779
Mailing Address - Fax:210-408-4568
Practice Address - Street 1:8503 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1841
Practice Address - Country:US
Practice Address - Phone:210-602-7779
Practice Address - Fax:210-408-4568
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist