Provider Demographics
NPI:1619536851
Name:FILLETTE, KIMBERLY ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:FILLETTE
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:PO BOX 1712
Mailing Address - Street 2:
Mailing Address - City:HAYFORK
Mailing Address - State:CA
Mailing Address - Zip Code:96041-1712
Mailing Address - Country:US
Mailing Address - Phone:530-721-0112
Mailing Address - Fax:
Practice Address - Street 1:3688 AVTECH PKWY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-9241
Practice Address - Country:US
Practice Address - Phone:530-999-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist