Provider Demographics
NPI:1700183845
Name:WIMBERLY, KELLI REEVES (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:REEVES
Last Name:WIMBERLY
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 1:2363 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-3735
Mailing Address - Country:US
Mailing Address - Phone:843-322-0308
Mailing Address - Fax:843-322-0669
Practice Address - Street 1:2363 BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-3735
Practice Address - Country:US
Practice Address - Phone:843-322-0308
Practice Address - Fax:843-322-0669
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist