Provider Demographics
NPI:1871869693
Name:MICHIE, KIMBERLY SHIN (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHIN
Last Name:MICHIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 MARVIN RD NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3870
Mailing Address - Country:US
Mailing Address - Phone:360-412-3488
Mailing Address - Fax:
Practice Address - Street 1:3842 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4427
Practice Address - Country:US
Practice Address - Phone:253-565-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH3142183500000X
WAPH60165839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist