Provider Demographics
NPI:1386943553
Name:FEDOR, KIMBERLEY IRENE (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:IRENE
Last Name:FEDOR
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 1:417 LANE CRES
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 BENNS CHURCH BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6063
Practice Address - Country:US
Practice Address - Phone:757-357-3254
Practice Address - Fax:757-357-3488
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208999183500000X
PARP440501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist