Healthcare Provider Details

I. General information

NPI: 1861493181
Provider Name (Legal Business Name): VANESSA KIM LOONEY PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 PEACH ORCHARD RD
AUGUSTA GA
30906-2406
US

IV. Provider business mailing address

2006 BRIAR CT
AUGUSTA GA
30907-3223
US

V. Phone/Fax

Practice location:
  • Phone: 706-798-5645
  • Fax: 706-798-0377
Mailing address:
  • Phone: 706-868-8963
  • Fax: 706-798-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH022420
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: