Provider Demographics
NPI:1053075127
Name:DUDZINSKI, KIMBERLY ANN (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:DUDZINSKI
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 1:181 SOPHRIRA LN
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6543
Mailing Address - Country:US
Mailing Address - Phone:814-946-4267
Mailing Address - Fax:
Practice Address - Street 1:181 SOPHRIRA LN
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6543
Practice Address - Country:US
Practice Address - Phone:814-946-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040057L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist