Provider Demographics
NPI:1336450477
Name:BRUMBAUGH, KIM ROBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:KIM
Middle Name:ROBERT
Last Name:BRUMBAUGH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DEVINE DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7650
Mailing Address - Country:US
Mailing Address - Phone:724-444-4681
Mailing Address - Fax:724-444-4681
Practice Address - Street 1:201 DEVINE DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7650
Practice Address - Country:US
Practice Address - Phone:724-444-4681
Practice Address - Fax:724-444-4681
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031675L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist