Provider Demographics
NPI:1487786992
Name:CLAYBORN, KIMBERLY RENEE (RPH, DN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEE
Last Name:CLAYBORN
Suffix:
Gender:F
Credentials:RPH, DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 N WOLCOTT AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5524
Mailing Address - Country:US
Mailing Address - Phone:312-286-5134
Mailing Address - Fax:
Practice Address - Street 1:7301 N WOLCOTT AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-5524
Practice Address - Country:US
Practice Address - Phone:312-286-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy