Provider Demographics
NPI:1073551271
Name:OOSTENINK, KIMBERLY JOY (RPH)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:JOY
Last Name:OOSTENINK
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 1:5350 ABBEY MILL BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7742
Mailing Address - Country:US
Mailing Address - Phone:616-464-6136
Mailing Address - Fax:
Practice Address - Street 1:4668 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3718
Practice Address - Country:US
Practice Address - Phone:616-949-0170
Practice Address - Fax:616-949-4073
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist