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General NPI Number Information
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NPI Number | 1376528349
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Entity Type | Individual
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Provider Name | KIMBERLY MARTIN HEAGY RPH
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1601 W BAY DR
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City | LARGO
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State | FL
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Zip | 33770-2209
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Country | US
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Telephone | 727-674-9990
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Fax | 727-674-9994
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Provider Business Mailing Address
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Address Line | 1686 21ST AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-5036
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Country | US
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Telephone | 727-897-9069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS31054
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License Number State | FL
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