Provider Demographics
NPI:1932198918
Name:BRISTOW, KIMBERLY P (RPH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:P
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 FORT PRINCE DR
Mailing Address - Street 2:
Mailing Address - City:WELLFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29385-9766
Mailing Address - Country:US
Mailing Address - Phone:864-949-6716
Mailing Address - Fax:707-222-3991
Practice Address - Street 1:228 FORT PRINCE DR
Practice Address - Street 2:
Practice Address - City:WELLFORD
Practice Address - State:SC
Practice Address - Zip Code:29385-9766
Practice Address - Country:US
Practice Address - Phone:864-949-6716
Practice Address - Fax:707-222-3991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85241835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy