Provider Demographics
NPI:1265048185
Name:WILLIAMS, KIM (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 YOUNG GULCH WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2902
Mailing Address - Country:US
Mailing Address - Phone:719-210-1890
Mailing Address - Fax:
Practice Address - Street 1:7353 SISTERS GRV
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2615
Practice Address - Country:US
Practice Address - Phone:719-355-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0019772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA.0019772OtherPHARMACY LICENSE NUMBER