Provider Demographics
NPI:1619244217
Name:KIMES, IVA OBERHOLSER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IVA
Middle Name:OBERHOLSER
Last Name:KIMES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 BOUNDARY ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-3827
Mailing Address - Country:US
Mailing Address - Phone:843-524-6207
Mailing Address - Fax:843-524-1952
Practice Address - Street 1:2127 BOUNDARY ST
Practice Address - Street 2:SUITE 19
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-3827
Practice Address - Country:US
Practice Address - Phone:843-524-6207
Practice Address - Fax:843-524-1952
Is Sole Proprietor?:No
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist