1588028997 NPI number — KIMPER PHARMACY INC

Table of content: (NPI 1588028997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588028997 NPI number — KIMPER PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMPER PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIMPER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588028997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 532
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHORN CITY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41522-0532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-424-8203
Provider Business Mailing Address Fax Number:
606-754-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9711 STATE HIGHWAY 194 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIMPER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41539-6232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-631-3327
Provider Business Practice Location Address Fax Number:
606-631-3320
Provider Enumeration Date:
04/12/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LESTER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-754-0221

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P07766 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2159484 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100408890 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".