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Organization
KIMBERLY PHARMACY, INC.
Active
Organization
KIMBERLY PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH JOHN VAN ASTEN RPH (PRESIDENT)
(920) 788-1940
Entity
Organization
Contact information
Practice address
110 E KIMBERLY AVE, KIMBERLY, WI 54136-1401
(920) 788-1940
(920) 788-3373
Mailing address
110 E KIMBERLY AVE, KIMBERLY, WI 54136-1401
(920) 788-1940
(920) 788-3373
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5651-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33078300
—
WI
01
—
5103887
NCPDP #
—
01
—
5651-042
PHARMACY LICENSE #
WI
Enumeration date
12/13/2006
Last updated
08/22/2020
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