Provider Demographics
NPI:1306626775
Name:ETHERTON, KIMBERLY BAUMANN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:BAUMANN
Last Name:ETHERTON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S MOUNT AUBURN RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6392
Mailing Address - Country:US
Mailing Address - Phone:573-519-4550
Mailing Address - Fax:573-519-4590
Practice Address - Street 1:817 S MOUNT AUBURN RD STE 130
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6392
Practice Address - Country:US
Practice Address - Phone:573-519-4550
Practice Address - Fax:573-519-4590
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003002135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist