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General NPI Number Information
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NPI Number | 1548830193
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Entity Type | Individual
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Provider Name | KIMBERLY NICOLE SMALLDON-LOUKS CPHT
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Gender | Female
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 06/27/2021
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Provider Practice Location Address
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Address Line | 1750 GRATIOT BLVD
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City | MARYSVILLE
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State | MI
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Zip | 48040-1182
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Country | US
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Telephone | 810-364-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 CHURCH ST
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City | PORT HURON
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State | MI
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Zip | 48060-2883
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Country | US
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Telephone | 810-292-2999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303036293
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License Number State | MI
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