Provider Demographics
NPI:1972109569
Name:RIGDON, KIMBERLY BLAKE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BLAKE
Last Name:RIGDON
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 1:1036 E FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3722
Mailing Address - Country:US
Mailing Address - Phone:229-924-6916
Mailing Address - Fax:
Practice Address - Street 1:1036 E FORSYTH ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3722
Practice Address - Country:US
Practice Address - Phone:229-924-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist