MEDICARE: DR. CHRISTINA KIMBALL PHARMD

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	12096	SC
2	183500000X	Pharmacist	22294	NC

General Provider Information

NPI Number	:	1023366655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA KIMBALL PHARMD

Provider Business Mailing Address
First Line	:	315 W BUTLER RD
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2531
Country	:	US
Telephone Number	:	864-288-1847
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 W BUTLER RD
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2531
Country	:	US
Telephone Number	:	864-288-1847
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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