Provider Demographics
NPI:1487646345
Name:PHILLIPS, KIMOTHY (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KIMOTHY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13895 MIDDLEBURG DECATURVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DECATURVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38329-5038
Mailing Address - Country:US
Mailing Address - Phone:731-968-3851
Mailing Address - Fax:731-847-6178
Practice Address - Street 1:18 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2012
Practice Address - Country:US
Practice Address - Phone:731-847-6337
Practice Address - Fax:731-847-6178
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist