=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275873960
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY A BOBERSCHMIDT PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2013
-----------------------------------------------------
Last Update Date | 02/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1397 WEIMER RD
-----------------------------------------------------
City | TAOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87571-6253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-737-3377
-----------------------------------------------------
Fax | 575-737-3339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1397 WEIMER RD
-----------------------------------------------------
City | TAOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87571-6253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-737-3377
-----------------------------------------------------
Fax | 575-737-3339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP00005075
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------