Provider Demographics
NPI:1407444797
Name:TALSMA, KIM RENEE (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:RENEE
Last Name:TALSMA
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 1:10172 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-8132
Mailing Address - Country:US
Mailing Address - Phone:806-983-8092
Mailing Address - Fax:
Practice Address - Street 1:420 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3125
Practice Address - Country:US
Practice Address - Phone:620-672-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist