Provider Demographics
NPI:1093116923
Name:BRUBAKER, KIMBERLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 PALM BAY RD NE
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8400
Mailing Address - Country:US
Mailing Address - Phone:321-984-1612
Mailing Address - Fax:321-984-2414
Practice Address - Street 1:845 PALM BAY RD NE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8400
Practice Address - Country:US
Practice Address - Phone:321-984-1612
Practice Address - Fax:321-984-2414
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist