Provider Demographics
NPI:1689108045
Name:SUKALICH, KIMBERLY ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:SUKALICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 DEARBORN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4767
Mailing Address - Country:US
Mailing Address - Phone:614-840-3571
Mailing Address - Fax:866-690-8967
Practice Address - Street 1:1250 DEARBORN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-4767
Practice Address - Country:US
Practice Address - Phone:614-840-3571
Practice Address - Fax:866-690-8967
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist