Provider Demographics
NPI:1457620304
Name:JOHNSON, KIMBERLY COLSTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:COLSTON
Last Name:JOHNSON
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 1:625 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3459
Mailing Address - Country:US
Mailing Address - Phone:719-473-8834
Mailing Address - Fax:719-473-0445
Practice Address - Street 1:625 N 19TH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3459
Practice Address - Country:US
Practice Address - Phone:719-473-8834
Practice Address - Fax:719-473-0445
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000011183500000X
AL14526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist