Provider Demographics
NPI:1396053724
Name:SHURDEN, KIMBERLY SHEA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHEA
Last Name:SHURDEN
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 1:8912 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-2414
Mailing Address - Country:US
Mailing Address - Phone:662-393-6300
Mailing Address - Fax:662-393-8930
Practice Address - Street 1:8912 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2414
Practice Address - Country:US
Practice Address - Phone:662-393-6300
Practice Address - Fax:662-393-8930
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS9555183500000X
TN32933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist