Provider Demographics
NPI:1891398475
Name:FORBES, KIMBERLY S (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:S
Last Name:FORBES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:A
Other - Last Name:STULL-FORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:478 RACCOON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAKANDA
Mailing Address - State:IL
Mailing Address - Zip Code:62958-2121
Mailing Address - Country:US
Mailing Address - Phone:618-203-1873
Mailing Address - Fax:
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1837
Practice Address - Country:US
Practice Address - Phone:618-997-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist