MEDICARE: KIMODALE, INC.

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	24314	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841339736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMODALE, INC.

Provider Business Mailing Address
First Line	:	7932 S. LOOP 12
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-6609
Country	:	US
Telephone Number	:	214-391-3101
Fax Number	:	214-398-6408

Provider Business Practice Location Address
First Line	:	7932 S. LOOP 12
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-6609
Country	:	US
Telephone Number	:	214-391-3101
Fax Number	:	214-398-6408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HAKIM N ALHADDAD
Credential	:
Telephone Number	:	214-391-3101

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2020

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Directions to “KIMODALE, INC. ” Practice Location

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