Provider Demographics
NPI:1861493181
Name:LOONEY, VANESSA KIM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:KIM
Last Name:LOONEY
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 1:2006 BRIAR CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3223
Mailing Address - Country:US
Mailing Address - Phone:706-868-8963
Mailing Address - Fax:706-798-0377
Practice Address - Street 1:2604 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2406
Practice Address - Country:US
Practice Address - Phone:706-798-5645
Practice Address - Fax:706-798-0377
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist