Healthcare Provider Details

I. General information

NPI: 1053781112
Provider Name (Legal Business Name): KIMBERLY GALE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 ARDEN WAY
SACRAMENTO CA
95825-2015
US

IV. Provider business mailing address

5721 ANGELINA AVE
CARMICHAEL CA
95608-3703
US

V. Phone/Fax

Practice location:
  • Phone: 707-486-8863
  • Fax:
Mailing address:
  • Phone: 707-486-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH 65998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: