Provider Demographics
NPI:1467425835
Name:WIMBERLEY, JUDY DIANNE (CERT PHARM TECH)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:DIANNE
Last Name:WIMBERLEY
Suffix:
Gender:F
Credentials:CERT PHARM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 OWENS DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5692
Mailing Address - Country:US
Mailing Address - Phone:731-642-1196
Mailing Address - Fax:
Practice Address - Street 1:1325 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4421
Practice Address - Country:US
Practice Address - Phone:731-642-0451
Practice Address - Fax:731-642-4034
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16381183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician