Provider Demographics
NPI:1780143594
Name:SANGIOVANNI, KIMBERLY SUE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:SANGIOVANNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SPOKANE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5159
Mailing Address - Country:US
Mailing Address - Phone:207-205-0563
Mailing Address - Fax:
Practice Address - Street 1:1524 LOCUST HILL RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6042
Practice Address - Country:US
Practice Address - Phone:864-801-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist