Provider Demographics
NPI:1053501833
Name:TOVTIN, KIMBERLEE JO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:JO
Last Name:TOVTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KIMBERLEE
Other - Middle Name:JO
Other - Last Name:GARGASZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5237 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:LOWELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44436-9563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2560
Practice Address - Country:US
Practice Address - Phone:330-332-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-28144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist