Provider Demographics
NPI:1245537372
Name:KIMBRELL, BETSY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:LYNN
Last Name:KIMBRELL
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 1:1537 CHARLESTON HWY
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5047
Mailing Address - Country:US
Mailing Address - Phone:803-796-3391
Mailing Address - Fax:803-796-9628
Practice Address - Street 1:1537 CHARLESTON HWY
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5047
Practice Address - Country:US
Practice Address - Phone:803-796-3391
Practice Address - Fax:803-796-9628
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC005227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist