Provider Demographics
NPI:1821876251
Name:KOLB, KIMBERLEY ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:KOLB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1201
Mailing Address - Country:US
Mailing Address - Phone:502-216-9604
Mailing Address - Fax:502-928-2790
Practice Address - Street 1:4003 KRESGE WAY STE 500
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5603
Practice Address - Country:US
Practice Address - Phone:502-721-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0107241835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835X0200XPharmacy Service ProvidersPharmacistOncologyGroup - Single Specialty