Provider Demographics
NPI:1578578191
Name:KIMODALE INC
Entity Type:Organization
Organization Name:KIMODALE INC
Other - Org Name:HUNTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAKIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-398-9786
Mailing Address - Street 1:PO BOX 170686
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-0686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7932 S LOOP 12
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-6609
Practice Address - Country:US
Practice Address - Phone:214-398-8113
Practice Address - Fax:214-398-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24314333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145401Medicaid
4574352OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4574352OtherOTHER ID NUMBER-COMMERCIAL NUMBER