Provider Demographics
NPI:1225407273
Name:THIMONS, KAMI (RPH)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:
Last Name:THIMONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 S CHALLIS ST
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-5441
Mailing Address - Country:US
Mailing Address - Phone:208-742-1285
Mailing Address - Fax:
Practice Address - Street 1:1026 S CHALLIS ST
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-5441
Practice Address - Country:US
Practice Address - Phone:208-742-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5123183500000X
IDCS6520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP5123OtherSTATE BOARD OF PHARMACY