Healthcare Provider Details

I. General information

NPI: 1588028997
Provider Name (Legal Business Name): KIMPER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 STATE HIGHWAY 194 E
KIMPER KY
41539-6232
US

IV. Provider business mailing address

PO BOX 532
ELKHORN CITY KY
41522-0532
US

V. Phone/Fax

Practice location:
  • Phone: 606-631-3327
  • Fax: 606-631-3320
Mailing address:
  • Phone: 606-424-8203
  • Fax: 606-754-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07766
License Number StateKY

VIII. Authorized Official

Name: ROBERT LESTER
Title or Position: OWNER
Credential:
Phone: 606-754-0221