Healthcare Provider Details

I. General information

NPI: 1700043650
Provider Name (Legal Business Name): KIMBERLY A MCCALL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SHADY AVE
DAMASCUS VA
24236
US

IV. Provider business mailing address

PO BOX 384
DAMASCUS VA
24236-0384
US

V. Phone/Fax

Practice location:
  • Phone: 276-475-5022
  • Fax: 275-475-3614
Mailing address:
  • Phone: 276-475-3224
  • Fax: 276-475-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206209
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000013124
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: