Provider Demographics
NPI:1437323755
Name:DAVIS, KIMBERLY RAE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:RAE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:25610 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8046
Mailing Address - Country:US
Mailing Address - Phone:248-486-9100
Mailing Address - Fax:248-486-5871
Practice Address - Street 1:25610 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8046
Practice Address - Country:US
Practice Address - Phone:248-486-9100
Practice Address - Fax:248-486-5871
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist