Provider Demographics
NPI:1962548222
Name:DICKEY, KIMBERLEY DENISE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:DENISE
Last Name:DICKEY
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 1:708 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2002
Mailing Address - Country:US
Mailing Address - Phone:801-673-2120
Mailing Address - Fax:
Practice Address - Street 1:400 W MOULTRIE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1716
Practice Address - Country:US
Practice Address - Phone:801-763-7951
Practice Address - Fax:801-763-7958
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210140211835P0018X
ARPD101411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist