Provider Demographics
NPI:1386231348
Name:FOX, KIM ANNETTE (RPH)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ANNETTE
Last Name:FOX
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 1:1527 BASHOR RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-1902
Mailing Address - Country:US
Mailing Address - Phone:574-533-5600
Mailing Address - Fax:574-533-6304
Practice Address - Street 1:1527 BASHOR RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-1902
Practice Address - Country:US
Practice Address - Phone:574-533-5600
Practice Address - Fax:866-409-6494
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015100A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist