Provider Demographics
NPI:1679985667
Name:BIRMINGHAM, KIM (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BIRMINGHAM
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 1:1224 E LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0400
Mailing Address - Country:US
Mailing Address - Phone:520-621-6516
Mailing Address - Fax:520-626-8628
Practice Address - Street 1:1224 E LOWELL ST
Practice Address - Street 2:ROOM A132
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0400
Practice Address - Country:US
Practice Address - Phone:520-621-6516
Practice Address - Fax:520-626-8628
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8650183500000X
AK1900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist