Provider Demographics
NPI:1841339587
Name:GORE, KIM RICE (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:RICE
Last Name:GORE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:JETERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23083-2213
Mailing Address - Country:US
Mailing Address - Phone:804-561-3804
Mailing Address - Fax:
Practice Address - Street 1:2105 ACADEMY RD
Practice Address - Street 2:SUITE E
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5829
Practice Address - Country:US
Practice Address - Phone:804-598-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist