Provider Demographics
NPI:1871003160
Name:KIMMY PHARMACY, LLC.
Entity Type:Organization
Organization Name:KIMMY PHARMACY, LLC.
Other - Org Name:GREENLAND PHARMACY #8
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-850-7373
Mailing Address - Street 1:8205 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-1201
Mailing Address - Country:US
Mailing Address - Phone:832-850-7373
Mailing Address - Fax:
Practice Address - Street 1:8205 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1201
Practice Address - Country:US
Practice Address - Phone:832-850-7373
Practice Address - Fax:281-317-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149704Medicaid