Healthcare Provider Details

I. General information

NPI: 1194819334
Provider Name (Legal Business Name): KIM T BOST PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 HISTORIC HOMER HWY HOMER DRUG CO.
HOMER GA
30547-2737
US

IV. Provider business mailing address

100 LAWRENCEVILLE ST
JEFFERSON GA
30549-1122
US

V. Phone/Fax

Practice location:
  • Phone: 706-677-3223
  • Fax:
Mailing address:
  • Phone: 706-202-3429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15823
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: