Provider Demographics
NPI:1699967554
Name:MYERS, KEMBA RASHEBA (PHARMD)
Entity type:Individual
Prefix:
First Name:KEMBA
Middle Name:RASHEBA
Last Name:MYERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 RED QUILL NEST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5519
Mailing Address - Country:US
Mailing Address - Phone:850-527-2378
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGGUIST DRIVE SUITE 1
Practice Address - Street 2:
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD18142OtherMD BOARD OF PHARMACY