Mike Kimbrough, D.PH.
Individual provider Active NPI Pharmacist · Marlow, OK
NPI 1316175441 · NPPES record last updated Jun 26, 2009
Key facts
- NPI
- 1316175441
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 11292 (OK)
- Practice address
- 801 S Broadway St
Marlow, OK 73055-3433 - Phone
- (580) 658-3784
- Fax
- (580) 658-3725
- NPI assigned
- Jun 26, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32126 | TX | MD | Psychologist |
| 11292 | OK | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11292 | OK | Yes |
| Pharmacist | 183500000X | 32126 | TX |
Addresses
Primary practice location
801 S Broadway St
Marlow, OK 73055-3433
Mailing address
801 S Broadway St
Marlow, OK 73055-3433
Phone (580) 658-3784
Other providers in Marlow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.