Individual
MS. KIMBERLY MICHELLE FAIRBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
1775 THOMPSON RD, COOS BAY, OR 97420-2125
(541) 269-8160
Mailing address
1951 BROADWAY ST, NORTH BEND, OR 97459-2325
(541) 751-0554
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CPT0000480
OR
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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