Provider Demographics
NPI:1649600719
Name:BECKER, KIMBERLEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:
Last Name:BECKER
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 1:5255 ELK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-5227
Mailing Address - Country:US
Mailing Address - Phone:406-546-5510
Mailing Address - Fax:
Practice Address - Street 1:5255 ELK RIDGE RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-5227
Practice Address - Country:US
Practice Address - Phone:406-546-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist