Provider Demographics
NPI:1831485945
Name:KIMMINAU, SHEILA SUE
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:SUE
Last Name:KIMMINAU
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 1:110 W MEADOWS DR
Mailing Address - Street 2:T-2029
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-8744
Mailing Address - Country:US
Mailing Address - Phone:970-945-8056
Mailing Address - Fax:970-945-8056
Practice Address - Street 1:110 W MEADOWS DR
Practice Address - Street 2:T-2029
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-8744
Practice Address - Country:US
Practice Address - Phone:970-945-8056
Practice Address - Fax:970-945-8056
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist