Provider Demographics
NPI:1821373804
Name:CORDOVA, KIMBERLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:CORDOVA
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 1:8745 COUNTY ROAD 9 S STE 152
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9610
Mailing Address - Country:US
Mailing Address - Phone:719-937-4750
Mailing Address - Fax:719-937-4778
Practice Address - Street 1:8745 COUNTY ROAD 9 S STE 152
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-9610
Practice Address - Country:US
Practice Address - Phone:719-937-4750
Practice Address - Fax:719-937-4778
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist