Provider Demographics
NPI:1184905549
Name:MULLINS, KIMBERLY JO (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:MULLINS
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 1:2005 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-7041
Mailing Address - Country:US
Mailing Address - Phone:859-363-3605
Mailing Address - Fax:859-363-3631
Practice Address - Street 1:2005 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7041
Practice Address - Country:US
Practice Address - Phone:859-363-3605
Practice Address - Fax:859-363-3631
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist