MEDICARE: MARY KIMMEL

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	0202219673	VA
2	183500000X	Pharmacist	RP452896	PA

General Provider Information

NPI Number	:	1346716503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KIMMEL

Provider Business Mailing Address
First Line	:	13616 BRITISH MANOR CT
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-1782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 CENTREVILLE RD
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-3639
Country	:	US
Telephone Number	:	814-444-2381
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	05/04/2026

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Directions to “ MARY KIMMEL ” Practice Location

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