Provider Demographics
NPI:1730451782
Name:MARKHAM, KIMBERLY A (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2270
Mailing Address - Country:US
Mailing Address - Phone:231-398-3202
Mailing Address - Fax:
Practice Address - Street 1:1057 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2270
Practice Address - Country:US
Practice Address - Phone:231-398-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist