Provider Demographics
NPI:1770739377
Name:VESELY, KIMBERLY ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:VESELY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 RUNNING HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3258
Mailing Address - Country:US
Mailing Address - Phone:207-871-0911
Mailing Address - Fax:
Practice Address - Street 1:200 RUNNING HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3258
Practice Address - Country:US
Practice Address - Phone:207-871-0911
Practice Address - Fax:207-871-0911
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist