Provider Demographics
NPI:1548661945
Name:PAGE, KIMBERLY (PHARM D)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:125 W ILA
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-8115
Mailing Address - Country:US
Mailing Address - Phone:512-470-9969
Mailing Address - Fax:
Practice Address - Street 1:3802 E ELMS RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-8542
Practice Address - Country:US
Practice Address - Phone:254-680-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist