Provider Demographics
NPI:1578566105
Name:NOLTE, KIMBERLY (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NOLTE
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 1:1550 200TH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-8583
Mailing Address - Country:US
Mailing Address - Phone:785-741-3998
Mailing Address - Fax:
Practice Address - Street 1:1550 200TH ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-8583
Practice Address - Country:US
Practice Address - Phone:785-741-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11170183500000X
MO42318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist