Healthcare Provider Details

I. General information

NPI: 1558732529
Provider Name (Legal Business Name): KIMBERLY AISHA STANFIELD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ROUTE 21 B AVE PO BOX 467
ZUNI NM
87327
US

IV. Provider business mailing address

301 ROUTE 21 B AVE PO BOX 467
ZUNI NM
87327
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-7518
  • Fax: 505-782-4502
Mailing address:
  • Phone: 505-782-7518
  • Fax: 505-782-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number202214438
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: