Provider Demographics
NPI:1255972352
Name:YAUGHN, KIMBERLY KAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:YAUGHN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 WATERINGHOLE CT
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-8671
Mailing Address - Country:US
Mailing Address - Phone:912-536-1137
Mailing Address - Fax:
Practice Address - Street 1:606 BRANNEN ST STE B
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5184
Practice Address - Country:US
Practice Address - Phone:912-225-9279
Practice Address - Fax:912-225-9284
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist