Provider Demographics
NPI:1871219618
Name:KIMREY, JOHN THOMAS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:KIMREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 FOOTHILLS MALL DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-5516
Mailing Address - Country:US
Mailing Address - Phone:865-379-7899
Mailing Address - Fax:
Practice Address - Street 1:220 FOOTHILLS MALL DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5516
Practice Address - Country:US
Practice Address - Phone:865-379-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist