Provider Demographics
NPI:1407589617
Name:PIMENTEL, KELVIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOUNT PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2822
Mailing Address - Country:US
Mailing Address - Phone:617-240-5116
Mailing Address - Fax:
Practice Address - Street 1:5550 WILD ROSE LN
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5350
Practice Address - Country:US
Practice Address - Phone:800-705-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist