Healthcare Provider Details

I. General information

NPI: 1902039720
Provider Name (Legal Business Name): KIMBERLY M BLANCHARD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY BARBER

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SOUTH SYCAMORE ST
ROSE HILL NC
28458
US

IV. Provider business mailing address

212 CORINTH CHURCH RD
ROSE HILL NC
28458-8319
US

V. Phone/Fax

Practice location:
  • Phone: 910-289-4271
  • Fax: 910-289-3880
Mailing address:
  • Phone: 910-289-4271
  • Fax: 910-289-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15951
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: