Provider Demographics
NPI:1154884310
Name:INGRAM, KIMBERLEY KAY (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:KAY
Last Name:INGRAM
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 1:2545 RIMROCK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8664
Mailing Address - Country:US
Mailing Address - Phone:970-248-0812
Mailing Address - Fax:970-248-0826
Practice Address - Street 1:2545 RIMROCK AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-8664
Practice Address - Country:US
Practice Address - Phone:970-248-0812
Practice Address - Fax:970-248-0826
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist