Provider Demographics
NPI:1851170468
Name:KIBONG, FLORA (PHARMD)
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:
Last Name:KIBONG
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 1:29434 ROSSLYN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2656
Mailing Address - Country:US
Mailing Address - Phone:734-546-8652
Mailing Address - Fax:
Practice Address - Street 1:36567 GODDARD RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1232
Practice Address - Country:US
Practice Address - Phone:734-941-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy