Provider Demographics
NPI:1326152620
Name:BECKLEY, KIMEBERLY ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMEBERLY
Middle Name:ANN
Last Name:BECKLEY
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 1:17657 ROSELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2738
Mailing Address - Country:US
Mailing Address - Phone:313-576-1000
Mailing Address - Fax:313-576-1105
Practice Address - Street 1:17657 ROSELAND BLVD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2738
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:313-576-1105
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist