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NPI Code Detail

MEDICARE: DR. KIMBERLY DIANE UTLEY PHARMD

MEDICARE: DR. KIMBERLY DIANE UTLEY PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist13465OK

General Provider Information

NPI Number : 1578559688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY DIANE UTLEY PHARMD
Provider Business Mailing Address
First Line : 1011 HONOR HEIGHTS DR
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-1318
Country : US
Telephone Number : 918-577-5786
Fax Number :
Provider Business Practice Location Address
First Line : 1011 HONOR HEIGHTS DR # 111T
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-1318
Country : US
Telephone Number : 918-577-3830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 09/18/2021

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