Healthcare Provider Details

I. General information

NPI: 1407111354
Provider Name (Legal Business Name): KIMBERLY WARD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 US HIGHWAY 60 W
LEWISPORT KY
42351-7214
US

IV. Provider business mailing address

8525 US HIGHWAY 60 W
LEWISPORT KY
42351-7214
US

V. Phone/Fax

Practice location:
  • Phone: 270-295-3356
  • Fax: 270-295-3055
Mailing address:
  • Phone: 270-295-3356
  • Fax: 270-295-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number009439
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26015412A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: