Provider Demographics
NPI:1356721856
Name:ROBISON, KIMBERLY ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:ROBISON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 DELL RANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4917
Mailing Address - Country:US
Mailing Address - Phone:307-274-9844
Mailing Address - Fax:307-274-9838
Practice Address - Street 1:1948 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4917
Practice Address - Country:US
Practice Address - Phone:307-274-9844
Practice Address - Fax:307-274-9838
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0019986183500000X
WY3690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3690OtherWYOMING STATE PHARMACY LICENSE
COPHA.0019986OtherCOLORADO STATE PHARMACY LICENSE