Provider Demographics
NPI:1699810663
Name:KIMA CORPORATION
Entity Type:Organization
Organization Name:KIMA CORPORATION
Other - Org Name:DAVIE BOULEVARD DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-583-9433
Mailing Address - Street 1:2629 DAVIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3029
Mailing Address - Country:US
Mailing Address - Phone:954-583-9433
Mailing Address - Fax:954-587-7863
Practice Address - Street 1:2629 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-3029
Practice Address - Country:US
Practice Address - Phone:954-583-9433
Practice Address - Fax:954-587-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH2523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy