Healthcare Provider Details

I. General information

NPI: 1407120264
Provider Name (Legal Business Name): KIMBERLY R GRIGSBY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2012
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FT RILEY KS
66442-4030
US

IV. Provider business mailing address

650 HUEBNER RD
FT RILEY KS
66442-4030
US

V. Phone/Fax

Practice location:
  • Phone: 785-240-7885
  • Fax: 785-240-8316
Mailing address:
  • Phone: 785-240-7866
  • Fax: 785-239-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13821
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13882
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number1-13882
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1-13882
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: