MEDICARE: MRS. KIMOTHY PHILLIPS PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8533	TN

General Provider Information

NPI Number	:	1487646345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMOTHY PHILLIPS PHARM D

Provider Business Mailing Address
First Line	:	13895 MIDDLEBURG DECATURVILLE RD
Second Line	:
City	:	DECATURVILLE
State	:	TN
Zip	:	38329-5038
Country	:	US
Telephone Number	:	731-968-3851
Fax Number	:	731-847-6178

Provider Business Practice Location Address
First Line	:	18 W MAIN ST
Second Line	:
City	:	PARSONS
State	:	TN
Zip	:	38363-2012
Country	:	US
Telephone Number	:	731-847-6337
Fax Number	:	731-847-6178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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