Provider Demographics
NPI:1124886197
Name:COLSTON, KIM R (RPH)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:R
Last Name:COLSTON
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 1:806 HICKORY FORK DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4754
Mailing Address - Country:US
Mailing Address - Phone:813-309-1085
Mailing Address - Fax:
Practice Address - Street 1:6216 E SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-9105
Practice Address - Country:US
Practice Address - Phone:813-549-8060
Practice Address - Fax:813-549-0051
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist