Provider Demographics
NPI:1598834947
Name:HALCOMB, KIM (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:HALCOMB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 VERONA LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5339
Mailing Address - Country:US
Mailing Address - Phone:865-363-3400
Mailing Address - Fax:865-986-4909
Practice Address - Street 1:501 ADESA BLVD
Practice Address - Street 2:SUITE A150
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771
Practice Address - Country:US
Practice Address - Phone:865-986-4530
Practice Address - Fax:865-986-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC006969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC006969OtherPHARMACY LICENSE NUMBER