Provider Demographics
NPI:1376094771
Name:LIPSCOMB, KYESHA ARIANE (PHARM D)
Entity Type:Individual
Prefix:
First Name:KYESHA
Middle Name:ARIANE
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2839
Mailing Address - Country:US
Mailing Address - Phone:269-983-0315
Mailing Address - Fax:
Practice Address - Street 1:1710 W JOHN BEERS RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9409
Practice Address - Country:US
Practice Address - Phone:269-429-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist