Provider Demographics
NPI:1417295973
Name:STOREY, KIM DESIREE
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DESIREE
Last Name:STOREY
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 1:1483 NASHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-7144
Mailing Address - Country:US
Mailing Address - Phone:615-451-7339
Mailing Address - Fax:615-451-7605
Practice Address - Street 1:1483 NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-7144
Practice Address - Country:US
Practice Address - Phone:615-451-7339
Practice Address - Fax:615-451-7605
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist