Provider Demographics
NPI:1760964472
Name:WINDHAM, KIMBERLY ELLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:WINDHAM
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 1:5418 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-6063
Mailing Address - Country:US
Mailing Address - Phone:606-802-2636
Mailing Address - Fax:606-802-2635
Practice Address - Street 1:5418 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6063
Practice Address - Country:US
Practice Address - Phone:606-802-2636
Practice Address - Fax:606-802-2635
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist