=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871003160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIMMY PHARMACY, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2017
-----------------------------------------------------
Last Update Date | 05/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8205 BROADWAY ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77061-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-850-7373
-----------------------------------------------------
Fax | 281-317-1972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8205 BROADWAY ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77061-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-850-7373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNY NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-850-7373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------