Provider Demographics
NPI:1609125988
Name:KING, KIMBERLY UNDERWOOD
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:UNDERWOOD
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 CHEROKEE ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8007
Mailing Address - Country:US
Mailing Address - Phone:843-849-6071
Mailing Address - Fax:
Practice Address - Street 1:650 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3013
Practice Address - Country:US
Practice Address - Phone:843-849-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist