Provider Demographics
NPI:1083264006
Name:HERSHBERGER, KIMBERLY A (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0975 N 00 EW
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761
Mailing Address - Country:US
Mailing Address - Phone:260-463-2583
Mailing Address - Fax:
Practice Address - Street 1:0975 N 00 EW
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761
Practice Address - Country:US
Practice Address - Phone:260-463-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028338A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist