Provider Demographics
NPI:1346402633
Name:GOULD, KIM ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ANN
Last Name:GOULD
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 1:525 W VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4454
Mailing Address - Country:US
Mailing Address - Phone:630-881-3582
Mailing Address - Fax:
Practice Address - Street 1:525 W VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4454
Practice Address - Country:US
Practice Address - Phone:630-881-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist