Active NPI
Kimberly Rae Davis, PHARMD
- Pharmacist
- South Lyon, MI
National Provider Identifier
1437323755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302038432
- Practice address
- 25610 Pontiac TRL
South Lyon, MI 48178-8046 - Phone
- (248) 486-9100
- Fax
- (248) 486-5871
- NPI assigned
- Apr 17, 2008
- Last updated
- Jul 23, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302038432 | MI | Primary |
Addresses
Primary practice location
25610 Pontiac TRL
South Lyon, MI 48178-8046
Mailing address
9995 E Grand River Ave
Brighton, MI 48116-1923
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 183500000X | Other | MI | TAXONOMY CODE PHARMACIST |
Other names 1
- Ms. Kimberly Rae Rice
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302038432 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| White Lake Pharmacy | Pharmacist | Current | Accepting new patients |
| Rite Aid of Michigan Inc | Past | Accepting new patients | |
| Rite Aid of Michigan Inc | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Rite Aid Pharmacy 04068
- Community/Retail Pharmacy
- Washington, MI
- NPI 1619117405
-
dba Rite Aid Pharmacy 04230
- Community/Retail Pharmacy
- South Lyon, MI
- NPI 1679682140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1437323755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9995 E GRAND RIVER AVE",
"city": "BRIGHTON",
"state": "MI",
"postal_code": "481161923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25610 PONTIAC TRL",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481788046",
"telephone_number": "248-486-9100",
"fax_number": "248-486-5871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KIMBERLY",
"middle_name": "RAE",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-17",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302038432",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAXONOMY CODE PHARMACIST",
"identifier": "183500000X",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "RICE",
"middle_name": "RAE",
"prefix": "MS.",
"credential": "PHARMD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in South Lyon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.