Provider Demographics
NPI:1598985921
Name:BURKES, KIM (RPH, BCNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BURKES
Suffix:
Gender:F
Credentials:RPH, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 N PUGET SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5844
Mailing Address - Country:US
Mailing Address - Phone:253-752-1705
Mailing Address - Fax:253-761-9315
Practice Address - Street 1:2302 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1300
Practice Address - Country:US
Practice Address - Phone:253-752-1705
Practice Address - Fax:253-761-9315
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2010-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21631183500000X, 1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear