Provider Demographics
NPI:1992047625
Name:DRUMMER- HOSEY, KIMBERLY NICOLE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:DRUMMER- HOSEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:NICOLE
Other - Last Name:DRUMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:419 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-3850
Mailing Address - Country:US
Mailing Address - Phone:601-425-5808
Mailing Address - Fax:601-425-9499
Practice Address - Street 1:419 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3850
Practice Address - Country:US
Practice Address - Phone:601-425-5808
Practice Address - Fax:601-425-9499
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS250101030355327183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician