Provider Demographics
NPI:1265779847
Name:TOOLE, KIMBERLY HEATHER
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:HEATHER
Last Name:TOOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 BULLSBORO DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1069
Mailing Address - Country:US
Mailing Address - Phone:770-502-1142
Mailing Address - Fax:770-502-1224
Practice Address - Street 1:370 BULLSBORO DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1069
Practice Address - Country:US
Practice Address - Phone:770-502-1142
Practice Address - Fax:770-502-1224
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist