Provider Demographics
NPI:1083913958
Name:HARTLEY, KIMBERLY WEST
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WEST
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 LOCUST HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6042
Mailing Address - Country:US
Mailing Address - Phone:864-801-3508
Mailing Address - Fax:
Practice Address - Street 1:1524 LOCUST HILL RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6042
Practice Address - Country:US
Practice Address - Phone:864-801-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist