Provider Demographics
NPI:1699048348
Name:THOMAS, KIMBERLY KERRY (CPHT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KERRY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SW EMIGRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1948
Mailing Address - Country:US
Mailing Address - Phone:541-276-7909
Mailing Address - Fax:541-276-2101
Practice Address - Street 1:901 SW EMIGRANT AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1948
Practice Address - Country:US
Practice Address - Phone:541-276-7909
Practice Address - Fax:541-276-2101
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0003180183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician