Healthcare Provider Details

I. General information

NPI: 1427749878
Provider Name (Legal Business Name): KIMAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 LOUDON RD STE 1A
CONCORD NH
03301-6091
US

IV. Provider business mailing address

239 LOUDON RD STE 1A
CONCORD NH
03301-6091
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2747
  • Fax: 603-227-6170
Mailing address:
  • Phone: 603-225-2747
  • Fax: 603-227-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTIN DONOVAN
Title or Position: NUTRITIONAL PHARMACIST
Credential: R.PH, DCN, DIP HERB
Phone: 603-225-2747