Provider Demographics
NPI:1801547278
Name:KIMANI, DEREK JOSEPH (PHARMD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JOSEPH
Last Name:KIMANI
Suffix:
Gender:M
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 672013
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77267-2013
Mailing Address - Country:US
Mailing Address - Phone:281-803-9877
Mailing Address - Fax:
Practice Address - Street 1:1706 NEWMARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2697
Practice Address - Country:US
Practice Address - Phone:281-803-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist