Provider Demographics
NPI:1841339736
Name:KIMODALE, INC.
Entity type:Organization
Organization Name:KIMODALE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAKIM
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALHADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-391-3101
Mailing Address - Street 1:7932 S. LOOP 12
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-6609
Mailing Address - Country:US
Mailing Address - Phone:214-391-3101
Mailing Address - Fax:214-398-6408
Practice Address - Street 1:7932 S. LOOP 12
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-6609
Practice Address - Country:US
Practice Address - Phone:214-391-3101
Practice Address - Fax:214-398-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145615Medicaid