Provider Demographics
NPI:1700043650
Name:MCCALL, KIMBERLY A (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:MCCALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:VA
Mailing Address - Zip Code:24236-0384
Mailing Address - Country:US
Mailing Address - Phone:276-475-3224
Mailing Address - Fax:276-475-3614
Practice Address - Street 1:204 SHADY AVE
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:VA
Practice Address - Zip Code:24236
Practice Address - Country:US
Practice Address - Phone:276-475-5022
Practice Address - Fax:275-475-3614
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206209183500000X
TN0000013124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202206209OtherVIRGINIA PHARMACIST LICENSE NUMBER
TN0000013124OtherTENNESSEE PHARMACIST LICENSE NUMBER