Kierstyn Thea Gillooly, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

2015026245 Issued in MO

Practice address

3721 W Truman Blvd
Jefferson City, MO 65109-6102

Phone

(573) 634-2628

Fax

(573) 635-1768

NPI assigned

Nov 12, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kierstyn Thea Fornoff Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1922600162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6635 STATE ROAD O",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652516362",
            "telephone_number": "573-220-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 W TRUMAN BLVD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096102",
            "telephone_number": "573-634-2628",
            "fax_number": "573-635-1768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLOOLY",
        "first_name": "KIERSTYN",
        "middle_name": "THEA",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-12",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2015026245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIERSTYN",
            "last_name": "FORNOFF",
            "middle_name": "THEA",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sam Giftos
• Haley Gilbert, M.S.
• Michael Giles
• Zoya Gill
• Anne Gilley
• Ashley Marie Ginter, PSY.D.
• Brandy Nicole Glascock, M.D.
• Mitchell Teruichi Godbee, MD
• Kimberly Goff, PTA
• Shaneika Gouldbourne, DMD

• Pharmacist in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.