Provider Demographics
NPI:1205432994
Name:LABAS, KIMBERLY BRASSEAL (RPH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BRASSEAL
Last Name:LABAS
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 1:11272 HIGHWAY 57
Mailing Address - Street 2:
Mailing Address - City:COUNCE
Mailing Address - State:TN
Mailing Address - Zip Code:38326-3802
Mailing Address - Country:US
Mailing Address - Phone:731-689-0223
Mailing Address - Fax:731-689-0253
Practice Address - Street 1:11272 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:COUNCE
Practice Address - State:TN
Practice Address - Zip Code:38326-3802
Practice Address - Country:US
Practice Address - Phone:731-689-0223
Practice Address - Fax:731-689-0253
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010107183500000X
TN27208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist