MEDICARE: KENDRA LEE KIMBER

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	066327-01	NY

General Provider Information

NPI Number	:	1639750565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA LEE KIMBER

Provider Business Mailing Address
First Line	:	424 CLEVELAND BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1108
Country	:	US
Telephone Number	:	315-420-0983
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 E BRIGHTON AVE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-4254
Country	:	US
Telephone Number	:	315-800-6400
Fax Number	:

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	10/27/2023

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Directions to “ KENDRA LEE KIMBER ” Practice Location

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