Healthcare Provider Details

I. General information

NPI: 1376700138
Provider Name (Legal Business Name): KIMS HOMETOWN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 S HIGHWAY 25 W
WILLIAMSBURG KY
40769-1918
US

IV. Provider business mailing address

PO BOX 98
WILLIAMSBURG KY
40769-0098
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-8700
  • Fax: 606-544-9555
Mailing address:
  • Phone: 606-549-8700
  • Fax: 606-549-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07255
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY JONES
Title or Position: OWNER,PIC,AO
Credential: RPH
Phone: 606-549-7645