Provider Demographics
NPI:1326197849
Name:VILLAJUANA, KIMBERLY CAMPBELL (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CAMPBELL
Last Name:VILLAJUANA
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 1:3928 AVIATOR DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1832
Mailing Address - Country:US
Mailing Address - Phone:325-696-3560
Mailing Address - Fax:
Practice Address - Street 1:697 LOUISIANA DR
Practice Address - Street 2:
Practice Address - City:DYESS AFB
Practice Address - State:TX
Practice Address - Zip Code:79607
Practice Address - Country:US
Practice Address - Phone:325-696-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist