Provider Demographics
NPI:1710432174
Name:SHAKUR, KIMBERLY HOLDEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HOLDEN
Last Name:SHAKUR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 GREEN VALLEY CIR
Mailing Address - Street 2:APT 200
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7078
Mailing Address - Country:US
Mailing Address - Phone:352-514-5582
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:B504A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8358
Practice Address - Country:US
Practice Address - Phone:310-267-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62797183500000X
FLPS40114183500000X
MA26380183500000X
HIPH3725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist