Provider Demographics
NPI:1528481967
Name:KIMBLEY, LISA JO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JO
Last Name:KIMBLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 E COMMERCE CENTER PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-4535
Mailing Address - Country:US
Mailing Address - Phone:520-837-0753
Mailing Address - Fax:520-837-0705
Practice Address - Street 1:2565 E COMMERCE CENTER PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-4535
Practice Address - Country:US
Practice Address - Phone:520-837-0753
Practice Address - Fax:520-837-0752
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist