Provider Demographics
NPI:1295017036
Name:ANKENBRUCK, KIMBERLY (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:ANKENBRUCK
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 1:6251 N 75 E
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:IN
Mailing Address - Zip Code:46791-9757
Mailing Address - Country:US
Mailing Address - Phone:260-543-2303
Mailing Address - Fax:
Practice Address - Street 1:1975 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1182
Practice Address - Country:US
Practice Address - Phone:260-824-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015364A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist