Healthcare Provider Details

I. General information

NPI: 1710380589
Provider Name (Legal Business Name): KIMBERLY ROBERTS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 N RANDOLPH AVE
ELKINS WV
26241-3969
US

IV. Provider business mailing address

1013 N RANDOLPH AVE
ELKINS WV
26241-3969
US

V. Phone/Fax

Practice location:
  • Phone: 681-342-3000
  • Fax: 681-342-3030
Mailing address:
  • Phone: 681-342-3000
  • Fax: 681-342-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0008135
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: