MEDICARE: GABRIEL THOMAS KIMBROUGH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2022032157	MO

General Provider Information

NPI Number	:	1205550795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL THOMAS KIMBROUGH PHARMD

Provider Business Mailing Address
First Line	:	8227 SW 3RD ST
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-7843
Country	:	US
Telephone Number	:	816-547-9808
Fax Number	:

Provider Business Practice Location Address
First Line	:	6244 BROOKSIDE BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1630
Country	:	US
Telephone Number	:	816-444-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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