Provider Demographics
NPI:1811058605
Name:MERRILL, KIMBERLY KAYE (RPH)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KAYE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 SARGENT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1244
Mailing Address - Country:US
Mailing Address - Phone:509-552-9338
Mailing Address - Fax:
Practice Address - Street 1:1275 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2846
Practice Address - Country:US
Practice Address - Phone:509-758-5533
Practice Address - Fax:509-751-9545
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6173801Medicaid
WA4902981OtherNABP NUMBER