Provider Demographics
NPI:1760891808
Name:KIMBLE, KIMBERLY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:KIMBLE
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 1:4109 E COOPER ST
Mailing Address - Street 2:APT A
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-8510
Mailing Address - Country:US
Mailing Address - Phone:304-771-9435
Mailing Address - Fax:
Practice Address - Street 1:1950 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2705
Practice Address - Country:US
Practice Address - Phone:520-458-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist