Provider Demographics
NPI:1083216964
Name:VLAHOS, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:VLAHOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9154 COUNTY HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:TREADWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13846-4612
Mailing Address - Country:US
Mailing Address - Phone:518-316-0429
Mailing Address - Fax:
Practice Address - Street 1:705 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3575
Practice Address - Country:US
Practice Address - Phone:607-432-0681
Practice Address - Fax:607-431-2543
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist