Provider Demographics
NPI:1265840649
Name:TYRRELL, KIMBERLY CATO (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CATO
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5303
Mailing Address - Country:US
Mailing Address - Phone:205-393-1765
Mailing Address - Fax:
Practice Address - Street 1:635 SKYLAND BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3934
Practice Address - Country:US
Practice Address - Phone:205-752-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist