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General NPI Number Information
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NPI Number | 1003418864
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Entity Type | Individual
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Provider Name | KIMBERLEE SUE AUTH RPH
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 1569 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10028-4003
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Country | US
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Telephone | 212-249-5198
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Fax |
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Provider Business Mailing Address
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Address Line | 317 E 89TH ST APT 1E
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City | NEW YORK
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State | NY
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Zip | 10128-5073
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Country | US
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Telephone | 309-830-1837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.286990
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 52294
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | I064109
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License Number State | NY
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