Provider Demographics
NPI:1174668545
Name:WILSON, KIMBERLY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:303 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4020
Mailing Address - Country:US
Mailing Address - Phone:701-223-2424
Mailing Address - Fax:
Practice Address - Street 1:303 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4020
Practice Address - Country:US
Practice Address - Phone:701-223-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist