Healthcare Provider Details

I. General information

NPI: 1538215231
Provider Name (Legal Business Name): KIMMY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 DORCHESTER AVE
DORCHESTER MA
02122-2915
US

IV. Provider business mailing address

1435 DORCHESTER AVE
DORCHESTER MA
02122-2915
US

V. Phone/Fax

Practice location:
  • Phone: 617-288-8199
  • Fax: 617-288-8191
Mailing address:
  • Phone: 617-288-8199
  • Fax: 617-288-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1888
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1888
License Number StateMA

VIII. Authorized Official

Name: MR. TUAN TRAN
Title or Position: OWNER
Credential: RPH
Phone: 617-288-8199