Provider Demographics
NPI:1902994221
Name:MCGUFFIN, KIMBERLY DEISHER (CPHT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DEISHER
Last Name:MCGUFFIN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 BRIDGE ST N
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:VA
Mailing Address - Zip Code:24066-5120
Mailing Address - Country:US
Mailing Address - Phone:540-254-1662
Mailing Address - Fax:
Practice Address - Street 1:19771 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:VA
Practice Address - Zip Code:24066
Practice Address - Country:US
Practice Address - Phone:540-254-2904
Practice Address - Fax:540-254-2907
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230002591183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician