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NPI Code Detail

MEDICARE: JEFFREY JOSEPH KIMMELL RPH

MEDICARE: JEFFREY JOSEPH KIMMELL RPH
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
1183500000XPharmacist26014974IN

General Provider Information

NPI Number : 1508183542
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY JOSEPH KIMMELL RPH
Provider Business Mailing Address
First Line : 13907 LAKE BEND CT
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-7022
Country : US
Telephone Number : 502-240-0635
Fax Number :
Provider Business Practice Location Address
First Line : 1901 CAMPUS PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2308
Country : US
Telephone Number : 502-627-7925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2010
Last Update Date : 04/30/2010

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