Provider Demographics
NPI:1124439963
Name:HARDESTY, KIMBERLY (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4719
Mailing Address - Country:US
Mailing Address - Phone:916-966-2266
Mailing Address - Fax:916-967-1720
Practice Address - Street 1:4830 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4719
Practice Address - Country:US
Practice Address - Phone:916-966-2266
Practice Address - Fax:916-967-1720
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist