Provider Demographics
NPI:1588028997
Name:KIMPER PHARMACY INC
Entity Type:Organization
Organization Name:KIMPER PHARMACY INC
Other - Org Name:KIMPER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-754-0221
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:ELKHORN CITY
Mailing Address - State:KY
Mailing Address - Zip Code:41522-0532
Mailing Address - Country:US
Mailing Address - Phone:606-424-8203
Mailing Address - Fax:606-754-0225
Practice Address - Street 1:9711 STATE HIGHWAY 194 E
Practice Address - Street 2:
Practice Address - City:KIMPER
Practice Address - State:KY
Practice Address - Zip Code:41539-6232
Practice Address - Country:US
Practice Address - Phone:606-631-3327
Practice Address - Fax:606-631-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP077663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159484OtherPK
KY7100408890Medicaid