Provider Demographics
NPI:1679696587
Name:NIMMO, KIMBERLY CHRISTINE (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHRISTINE
Last Name:NIMMO
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 1:1100 GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5933
Mailing Address - Country:US
Mailing Address - Phone:307-265-8627
Mailing Address - Fax:
Practice Address - Street 1:1100 GRANADA AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-5933
Practice Address - Country:US
Practice Address - Phone:307-265-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist