Provider Demographics
NPI:1740253293
Name:ZIETLOW, KIMBERLY ANNETTE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:ZIETLOW
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 1:56482 169TH AVE
Mailing Address - Street 2:
Mailing Address - City:GONVICK
Mailing Address - State:MN
Mailing Address - Zip Code:56644-4243
Mailing Address - Country:US
Mailing Address - Phone:218-679-3912
Mailing Address - Fax:218-679-0189
Practice Address - Street 1:HWY 1
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:218-679-0189
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE103011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy