Active NPI
Kimberly Michelle Fairbank, CPHT
- Pharmacy Technician
- Coos Bay, OR
National Provider Identifier
1669563003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- CPT0000480
- Practice address
- 1775 Thompson Rd
Coos Bay, OR 97420-2125 - Phone
- (541) 269-8160
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | CPT0000480 | OR | Primary |
Addresses
Primary practice location
1775 Thompson Rd
Coos Bay, OR 97420-2125
Mailing address
1951 Broadway St
North Bend, OR 97459-2325
Phone (541) 751-0554
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPT0000480 | OR | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669563003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1951 BROADWAY ST",
"city": "NORTH BEND",
"state": "OR",
"postal_code": "974592325",
"telephone_number": "541-751-0554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 THOMPSON RD",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202125",
"telephone_number": "541-269-8160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRBANK",
"first_name": "KIMBERLY",
"middle_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "CPHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "OR",
"license": "CPT0000480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.