Kimberly Anne Wildermuth, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

051620 Issued in NY

Practice address

73 N Main St
Big M Shopping Center
Brockport, NY 14420-1648

Phone

(585) 637-1151

NPI assigned

Dec 13, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rite Aid of New York Inc

  • Community/Retail Pharmacy
  • Brockport, NY
  • NPI 1740399070
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266537600000",
    "number": "1407039449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 N MAIN ST",
            "address_2": "BIG M SHOPPING CENTER",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201648",
            "telephone_number": "585-637-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 N MAIN ST",
            "address_2": "BIG M SHOPPING CENTER",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201648",
            "telephone_number": "585-637-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDERMUTH",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-13",
        "last_updated": "2010-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "051620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01259003",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beverly Whiteman, RN BSN
• Stephen F Wieczorek, DPM
• Susan Mary Wielgosz, ATC
• Carol Jean Wilbur, CCC-SLP
• Casey E Wilcox, LCSW
• Christina Faig William, MD
• Yvonne M Williams, OD
• Abigail Naomi Wilson, NP
• Eric Alexander Winnie, DDS
• Matthew T Wiza, DO

• Pharmacist in Brockport, NY
• Providers in Brockport, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.