Provider Demographics
NPI:1215230719
Name:APPALACHIAN WELLNESS INC
Entity Type:Organization
Organization Name:APPALACHIAN WELLNESS INC
Other - Org Name:DBA KIM'S COMPOUNDS AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-452-0911
Mailing Address - Street 1:366 RUSS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2905
Mailing Address - Country:US
Mailing Address - Phone:828-452-0911
Mailing Address - Fax:828-452-0912
Practice Address - Street 1:366 RUSS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-2905
Practice Address - Country:US
Practice Address - Phone:828-452-0911
Practice Address - Fax:828-452-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106373336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10637OtherNORTH CAROLINA BOARD OF PHARMACY
NC10637OtherNORTH CAROLINA BOARD OF PHARMACY