Basic Information
| Provider Information | |||||||||
| NPI: | 1558028415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THURSTON | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 LOCKER RD | ||||||||
| Address2: | |||||||||
| City: | RIMERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162488246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142279715 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 FAIRFIELD DR | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163462130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146767600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2021 | ||||||||
| LastUpdateDate: | 11/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RP456351 | PA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.