Provider Demographics
NPI:1972148484
Name:MONTGOMERY, KIMBERLY DAWN (PHARMD-RPH)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHARMD-RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S 25 MILE AVE
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-4801
Mailing Address - Country:US
Mailing Address - Phone:806-364-3400
Mailing Address - Fax:806-364-3405
Practice Address - Street 1:809 S 25 MILE AVE
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-4801
Practice Address - Country:US
Practice Address - Phone:806-364-3400
Practice Address - Fax:806-364-3405
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX425371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX42537OtherPHARMACY LICENSE