Provider Demographics
NPI:1043506686
Name:TOMLIN, KIMBERLY S (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:TOMLIN
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 1:12000 RETAIL DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7353
Mailing Address - Country:US
Mailing Address - Phone:919-761-1002
Mailing Address - Fax:919-761-1002
Practice Address - Street 1:12000 RETAIL DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7353
Practice Address - Country:US
Practice Address - Phone:919-761-1002
Practice Address - Fax:919-761-1002
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19281183500000X
NC15313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist