Provider Demographics
NPI:1568450765
Name:KIMTRE CORP.
Entity Type:Organization
Organization Name:KIMTRE CORP.
Other - Org Name:CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-947-5550
Mailing Address - Street 1:251 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5709
Mailing Address - Country:US
Mailing Address - Phone:201-947-5550
Mailing Address - Fax:201-947-0514
Practice Address - Street 1:251 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5709
Practice Address - Country:US
Practice Address - Phone:201-947-5550
Practice Address - Fax:201-947-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00418400332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4399013Medicaid
NJ4399005Medicaid
NJ3851310001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER