Healthcare Provider Details

I. General information

NPI: 1437323755
Provider Name (Legal Business Name): KIMBERLY RAE DAVIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY RAE RICE PHARMD

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25610 PONTIAC TRL
SOUTH LYON MI
48178-8046
US

IV. Provider business mailing address

9995 E GRAND RIVER AVE
BRIGHTON MI
48116-1923
US

V. Phone/Fax

Practice location:
  • Phone: 248-486-9100
  • Fax: 248-486-5871
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: