Provider Demographics
NPI:1346419025
Name:GRUBBS, KIMBERLY DAWN (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:GRUBBS
Other - Last Name:CROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2091 KEENELAND DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5920
Mailing Address - Country:US
Mailing Address - Phone:706-202-4049
Mailing Address - Fax:706-583-8905
Practice Address - Street 1:2091 KEENELAND DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5920
Practice Address - Country:US
Practice Address - Phone:706-202-4049
Practice Address - Fax:706-583-8905
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist