Provider Demographics
NPI:1588970768
Name:RIEGO, KIMBERLY KIM (PHARMD)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KIM
Last Name:RIEGO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11363 BUCKEYE HILL CT
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7247
Mailing Address - Country:US
Mailing Address - Phone:213-706-4019
Mailing Address - Fax:
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-784-4526
Practice Address - Fax:916-784-4322
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist