Individual
KATIE TOMBLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1257 CLAY JACK RD, RUSH, KY 41168
(304) 942-5623
Mailing address
1257 CLAY JACK RD, RUSH, KY 41168
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
IN0007920
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN0007920
WV INTERN LICENSE
WV
Enumeration date
03/30/2018
Last updated
03/30/2018
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