Provider Demographics
NPI:1710395231
Name:KIMBALL, ANGELA DANNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DANNA
Last Name:KIMBALL
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 1:8713 64TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7704
Mailing Address - Country:US
Mailing Address - Phone:360-386-3011
Mailing Address - Fax:360-386-3005
Practice Address - Street 1:8713 64TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7704
Practice Address - Country:US
Practice Address - Phone:360-386-3011
Practice Address - Fax:360-386-3005
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist