Healthcare Provider Details

I. General information

NPI: 1265170161
Provider Name (Legal Business Name): KIMBERLY ANN CARRAWAY PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2022
Last Update Date: 05/22/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OAKDALE RD STE E
MODESTO CA
95355-2257
US

IV. Provider business mailing address

2601 OAKDALE RD STE E
MODESTO CA
95355-2257
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-4932
  • Fax: 209-526-9945
Mailing address:
  • Phone: 209-523-4932
  • Fax: 209-526-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: