Provider Demographics
NPI:1780083741
Name:KESSELL, KIMBERLY (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:KESSELL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WINDSOR MALL APT 3M
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3641
Mailing Address - Country:US
Mailing Address - Phone:773-682-7279
Mailing Address - Fax:
Practice Address - Street 1:2500 WINDSOR MALL APT 3M
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3641
Practice Address - Country:US
Practice Address - Phone:773-682-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist