Provider Demographics
NPI:1831783950
Name:ST. JOHN, KIMBERLY (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOMESTEAD FARM RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2701
Mailing Address - Country:US
Mailing Address - Phone:802-343-8814
Mailing Address - Fax:
Practice Address - Street 1:155 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444-9665
Practice Address - Country:US
Practice Address - Phone:802-644-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0002996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist