Provider Demographics
NPI:1063180107
Name:DO, KIMBERLY PHAM (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PHAM
Last Name:DO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 BRIGHTON LAKE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4761
Mailing Address - Country:US
Mailing Address - Phone:346-400-1162
Mailing Address - Fax:
Practice Address - Street 1:13484 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-6007
Practice Address - Country:US
Practice Address - Phone:713-690-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist