Provider Demographics
NPI:1245909662
Name:LIOY, KIMBERLY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:LIOY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:RASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2601 S HOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1525
Mailing Address - Country:US
Mailing Address - Phone:520-751-8523
Mailing Address - Fax:
Practice Address - Street 1:2601 S HOUGHTON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1525
Practice Address - Country:US
Practice Address - Phone:520-751-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD07502033Medicaid