Provider Demographics
NPI:1669003976
Name:ABSHIRE, KIMLA GAIL
Entity Type:Individual
Prefix:
First Name:KIMLA
Middle Name:GAIL
Last Name:ABSHIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3497
Mailing Address - Country:US
Mailing Address - Phone:281-422-8034
Mailing Address - Fax:281-425-8890
Practice Address - Street 1:1700 N ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3497
Practice Address - Country:US
Practice Address - Phone:281-422-8034
Practice Address - Fax:281-425-8890
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX359781835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist