Provider Demographics
NPI:1194027086
Name:CLOUSE, KIMBERLY S (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:S
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:HOFFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1887 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-9249
Mailing Address - Country:US
Mailing Address - Phone:570-888-3726
Mailing Address - Fax:
Practice Address - Street 1:1887 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-9249
Practice Address - Country:US
Practice Address - Phone:570-888-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist