Provider Demographics
NPI:1073104782
Name:FROMM, KIMBERLY JO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JO
Last Name:FROMM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11600 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62984-3512
Mailing Address - Country:US
Mailing Address - Phone:618-201-0658
Mailing Address - Fax:618-272-3851
Practice Address - Street 1:101 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:IL
Practice Address - Zip Code:62984
Practice Address - Country:US
Practice Address - Phone:618-272-3841
Practice Address - Fax:618-272-3851
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist