Provider Demographics
NPI:1104101484
Name:ECKERLE, KIMBERLY FITZGERALD (RPH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FITZGERALD
Last Name:ECKERLE
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 1:305 SHALLOWFORD PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6209
Mailing Address - Country:US
Mailing Address - Phone:502-244-5484
Mailing Address - Fax:502-254-3665
Practice Address - Street 1:305 SHALLOWFORD PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6209
Practice Address - Country:US
Practice Address - Phone:502-244-5484
Practice Address - Fax:502-254-3665
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist