Healthcare Provider Details

I. General information

NPI: 1013324953
Provider Name (Legal Business Name): KIMBERLEY PETER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR GERALD CHAMPION REGIONAL MEDICAL CENTER, PHARMACY DEPT.
ALAMOGORDO NM
88310-8700
US

IV. Provider business mailing address

2 CALLE DE SUENOS
ALAMOGORDO NM
88310-9537
US

V. Phone/Fax

Practice location:
  • Phone: 575-443-7979
  • Fax:
Mailing address:
  • Phone: 915-433-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP00007762
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number34008
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: