Provider Demographics
NPI:1235523606
Name:BULLEN, KIMBERLY LYNNE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:BULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 VALLEY RUN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3438
Mailing Address - Country:US
Mailing Address - Phone:478-335-0991
Mailing Address - Fax:
Practice Address - Street 1:839 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1996
Practice Address - Country:US
Practice Address - Phone:606-864-7368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist