Provider Demographics
NPI:1821501321
Name:OHNESORGE, KIMBERLY AE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:AE
Last Name:OHNESORGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:AE
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1776 W LAKES PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8378
Mailing Address - Country:US
Mailing Address - Phone:515-241-7569
Mailing Address - Fax:515-241-7536
Practice Address - Street 1:1776 W LAKES PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8378
Practice Address - Country:US
Practice Address - Phone:515-241-7569
Practice Address - Fax:515-241-7536
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist