Provider Demographics
NPI:1508863192
Name:CROLEY, KIMBERLY SASSER (PHARMD, CGP, FASCP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SASSER
Last Name:CROLEY
Suffix:
Gender:F
Credentials:PHARMD, CGP, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1305
Mailing Address - Country:US
Mailing Address - Phone:606-523-5720
Mailing Address - Fax:
Practice Address - Street 1:317 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1305
Practice Address - Country:US
Practice Address - Phone:606-523-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93921835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy