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General NPI Number Information
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NPI Number | 1376700138
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Entity Type | Organization
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Legal Business Name | KIMS HOMETOWN PHARMACY INC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 865 S HIGHWAY 25 W
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City | WILLIAMSBURG
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State | KY
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Zip | 40769-1918
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Country | US
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Telephone | 606-549-8700
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Fax | 606-544-9555
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Provider Business Mailing Address
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Address Line | PO BOX 98
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City | WILLIAMSBURG
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State | KY
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Zip | 40769-0098
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Country | US
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Telephone | 606-549-8700
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Fax | 606-549-4555
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Authorized Official
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Title or Position | OWNER,PIC,AO
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Name | KIMBERLY JONES
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Credential | RPH
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Telephone | 606-549-7645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07255
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License Number State | KY
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