Provider Demographics
NPI:1851994040
Name:POOL-MASON, KIMBERLY NOELLE (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NOELLE
Last Name:POOL-MASON
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 1:7801 ASTRA CIR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9755
Mailing Address - Country:US
Mailing Address - Phone:614-562-2283
Mailing Address - Fax:
Practice Address - Street 1:6030 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1685
Practice Address - Country:US
Practice Address - Phone:614-245-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-3-20068OtherSTATE BOARD OF PHARMACY