Provider Demographics
NPI:1992059869
Name:KIERNAN, KIMBERLY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:KIERNAN
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:PO BOX 2585
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-2585
Mailing Address - Country:US
Mailing Address - Phone:561-294-6288
Mailing Address - Fax:
Practice Address - Street 1:176 LAKE DR STE 1201
Practice Address - Street 2:
Practice Address - City:PALM BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:33404-5788
Practice Address - Country:US
Practice Address - Phone:561-294-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992059869OtherNPI - NATIONAL PROVIDER ID