Provider Demographics
NPI:1992395560
Name:LARUE, KIM (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:LARUE
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:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:AL
Mailing Address - Zip Code:35049-0207
Mailing Address - Country:US
Mailing Address - Phone:205-274-8000
Mailing Address - Fax:205-274-8019
Practice Address - Street 1:36321 STATE HIGHWAY 79 STE 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:AL
Practice Address - Zip Code:35049-3556
Practice Address - Country:US
Practice Address - Phone:205-274-8000
Practice Address - Fax:205-274-8019
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist