Provider Demographics
NPI:1962173377
Name:ARD, KIMBERLY FRYE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FRYE
Last Name:ARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-1422
Mailing Address - Country:US
Mailing Address - Phone:803-484-3784
Mailing Address - Fax:803-484-4778
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1422
Practice Address - Country:US
Practice Address - Phone:803-484-3784
Practice Address - Fax:803-484-4778
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist