Provider Demographics
NPI:1053917427
Name:SMITH, KIMBERLY HUGHES
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HUGHES
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 US HIGHWAY 331 S STE G
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-3391
Mailing Address - Country:US
Mailing Address - Phone:850-892-9668
Mailing Address - Fax:
Practice Address - Street 1:1030 US HIGHWAY 331 S STE G
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3391
Practice Address - Country:US
Practice Address - Phone:850-892-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist