=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588028997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIMPER PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2016
-----------------------------------------------------
Last Update Date | 08/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9711 STATE HIGHWAY 194 E
-----------------------------------------------------
City | KIMPER
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41539-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-631-3327
-----------------------------------------------------
Fax | 606-631-3320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 532
-----------------------------------------------------
City | ELKHORN CITY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41522-0532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-424-8203
-----------------------------------------------------
Fax | 606-754-0225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT LESTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-754-0221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | P07766
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------