Provider Demographics
NPI:1194819334
Name:BOST, KIM T (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:T
Last Name:BOST
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAWRENCEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-1122
Mailing Address - Country:US
Mailing Address - Phone:706-202-3429
Mailing Address - Fax:
Practice Address - Street 1:1228 HISTORIC HOMER HWY
Practice Address - Street 2:HOMER DRUG CO.
Practice Address - City:HOMER
Practice Address - State:GA
Practice Address - Zip Code:30547-2737
Practice Address - Country:US
Practice Address - Phone:706-677-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist