Organization
KIMBERLY HOMETOWN PHARMACY LLC
Active
Other names
Kimberly Hometown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE L DEANS (CONTRACTING MANAGER)
(920) 992-6800
Entity
Organization
Contact information
Practice address
W2721 BROOKHAVEN DR, APPLETON, WI 54915-8184
(920) 423-3438
(920) 423-3489
Mailing address
333 LOWVILLE RD, RIO, WI 53960-9437
(920) 992-6800
(920) 614-6100
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100382764
—
WI
Enumeration date
02/18/2019
Last updated
12/02/2025
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