MEDICARE: KIMBERLY NOELLE POOL-MASON RPH

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	03-3-20068	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03-3-20068	OTHER	OH	STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1851994040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY NOELLE POOL-MASON RPH

Provider Business Mailing Address
First Line	:	7801 ASTRA CIR
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-9755
Country	:	US
Telephone Number	:	614-562-2283
Fax Number	:

Provider Business Practice Location Address
First Line	:	6030 N HAMILTON RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-1685
Country	:	US
Telephone Number	:	614-245-6033
Fax Number	:

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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Directions to “ KIMBERLY NOELLE POOL-MASON RPH” Practice Location

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