Provider Demographics
NPI:1992352413
Name:COTTRELL, KIMBERLY ROSE (RPH)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ROSE
Last Name:COTTRELL
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 1:744 N WACO AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3936
Mailing Address - Country:US
Mailing Address - Phone:316-263-5218
Mailing Address - Fax:
Practice Address - Street 1:744 N WACO AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3936
Practice Address - Country:US
Practice Address - Phone:316-263-5218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-109631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist