Provider Demographics
NPI:1588914170
Name:WANG, KIMBERLY (PHARM D)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2109
Mailing Address - Country:US
Mailing Address - Phone:516-671-4908
Mailing Address - Fax:
Practice Address - Street 1:93 FOREST AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2109
Practice Address - Country:US
Practice Address - Phone:516-671-4908
Practice Address - Fax:516-672-0317
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist