Provider Demographics
NPI:1063082436
Name:BIRMINGHAM, SHIRLEY LOUISE
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LOUISE
Last Name:BIRMINGHAM
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 1:13137 W ARMOUR LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-9512
Mailing Address - Country:US
Mailing Address - Phone:269-419-5071
Mailing Address - Fax:
Practice Address - Street 1:RITE AID
Practice Address - Street 2:30 E COLUMBIA AVE STEA
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015
Practice Address - Country:US
Practice Address - Phone:269-965-3237
Practice Address - Fax:269-965-6114
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303037770183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician