Individual
KIMBERLY RIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1258 TUCKAWANNA DR SW, ATLANTA, GA 30311-3122
(678) 576-5166
Mailing address
PO BOX 42829, ATLANTA, GA 30311-0829
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH032978
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NON MEDICAID
GA
Enumeration date
06/12/2022
Last updated
06/12/2022
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