Provider Demographics
NPI:1982851358
Name:BAHMA, KIMBERLY JOY (RPH, PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JOY
Last Name:BAHMA
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 BANDANA BLVD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108
Mailing Address - Country:US
Mailing Address - Phone:651-917-6125
Mailing Address - Fax:651-641-0341
Practice Address - Street 1:1295 BANDANA BLVD
Practice Address - Street 2:SUITE 335
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108
Practice Address - Country:US
Practice Address - Phone:651-917-6125
Practice Address - Fax:651-641-0341
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist