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General NPI Number Information
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NPI Number | 1770973406
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Entity Type | Organization
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Legal Business Name | PRO KIMA, LLC
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 1891 N LEE TREVINO DR STE 200
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City | EL PASO
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State | TX
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Zip | 79936-4132
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Country | US
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Telephone | 915-629-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 1891 N LEE TREVINO DR # 200
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City | EL PASO
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State | TX
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Zip | 79936-4127
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Country | US
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Telephone | 915-629-2020
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | PEYMAN KIMASI
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Credential |
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Telephone | 503-975-0925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29737
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License Number State | TX
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