MEDICARE: MS. KIMBERLY KAYE MERRILL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00021095	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4902981	OTHER	WA	NABP NUMBER

General Provider Information

NPI Number	:	1811058605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY KAYE MERRILL RPH

Provider Business Mailing Address
First Line	:	1941 SARGENT DR
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-1244
Country	:	US
Telephone Number	:	509-552-9338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 HIGHLAND AVE
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2846
Country	:	US
Telephone Number	:	509-758-5533
Fax Number	:	509-751-9545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	02/18/2010

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