Provider Demographics
NPI:1710258256
Name:BIENVILLE, KIMBERLEY LAM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:LAM
Last Name:BIENVILLE
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 1:25465 SE 275TH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-2037
Mailing Address - Country:US
Mailing Address - Phone:206-491-2414
Mailing Address - Fax:
Practice Address - Street 1:11718 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3544
Practice Address - Country:US
Practice Address - Phone:253-770-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60030817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist