Active NPI
Ken A Kimball, RPH
- Pharmacist
- Fort Wayne, IN
National Provider Identifier
1518506047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26016357A
- Practice address
- 2802 E State Blvd
Fort Wayne, IN 46805-4733 - Phone
- (260) 471-5521
- NPI assigned
- Jan 1, 2020
- Last updated
- Jan 1, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26016357A | IN | Primary |
Addresses
Primary practice location
2802 E State Blvd
Fort Wayne, IN 46805-4733
Mailing address
11606 Hardisty Rd
Fort Wayne, IN 46845-9606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26016357A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hook-Superx LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577836800000",
"number": "1518506047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11606 HARDISTY RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468459606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2802 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468054733",
"telephone_number": "260-471-5521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "KEN",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-01",
"last_updated": "2020-01-01",
"certification_date": "2020-01-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26016357A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.