Provider Demographics
NPI:1700168895
Name:BOOTS, KIMBERLY DALE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DALE
Last Name:BOOTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DALE
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2560 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2407
Mailing Address - Country:US
Mailing Address - Phone:330-746-4814
Mailing Address - Fax:330-746-4794
Practice Address - Street 1:2560 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2407
Practice Address - Country:US
Practice Address - Phone:330-746-4814
Practice Address - Fax:330-746-4794
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-19842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist