Provider Demographics
NPI:1770985913
Name:RAGLAND, KIMBERLY MICHELLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MICHELLE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11715 RAINWOOD RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212
Mailing Address - Country:US
Mailing Address - Phone:501-223-2636
Mailing Address - Fax:501-224-5253
Practice Address - Street 1:49 N FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135
Practice Address - Country:US
Practice Address - Phone:314-524-4144
Practice Address - Fax:314-524-8650
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12865183500000X
MO2015030933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist