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General NPI Number Information
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NPI Number | 1871869693
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Entity Type | Individual
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Provider Name | KIMBERLY SHIN MICHIE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 3842 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4427
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Country | US
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Telephone | 253-565-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 MARVIN RD NE
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City | LACEY
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State | WA
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Zip | 98516-3870
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Country | US
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Telephone | 360-412-3488
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH3142
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60165839
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License Number State | WA
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