Healthcare Provider Details

I. General information

NPI: 1700977451
Provider Name (Legal Business Name): KIMBERLY SMITH CANADAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY DIANE PADGETT PHARMD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-3151
  • Fax: 904-653-4669
Mailing address:
  • Phone: 904-259-3151
  • Fax: 904-653-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS50472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: