Healthcare Provider Details

I. General information

NPI: 1851435788
Provider Name (Legal Business Name): KIMBERLY A. THRASHER PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST COASTAL AHEC
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

2131 S 17TH ST COASTAL AHEC
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0161
  • Fax: 910-762-9203
Mailing address:
  • Phone: 910-343-0161
  • Fax: 910-762-9203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number08160
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: