Provider Demographics
NPI:1184806341
Name:EGBERT-KIBLER, JENNIFER (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EGBERT-KIBLER
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 1:4183 CREEKS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-8983
Mailing Address - Country:US
Mailing Address - Phone:734-891-8623
Mailing Address - Fax:
Practice Address - Street 1:50 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2217
Practice Address - Country:US
Practice Address - Phone:248-338-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist