Provider Demographics
NPI:1336749738
Name:SYERS, KIM MARIE
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:SYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 RIVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6350
Mailing Address - Country:US
Mailing Address - Phone:630-399-1146
Mailing Address - Fax:
Practice Address - Street 1:2900 KIRK RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-6015
Practice Address - Country:US
Practice Address - Phone:630-375-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-038377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist