Kimper Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Kimper, KY
NPI 1588028997 · NPPES record last updated Aug 2, 2016
Key facts
- NPI
- 1588028997
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- P07766 (KY)
- Legal business name
- KIMPER PHARMACY INC
- Practice address
- 9711 State Highway 194 E
Kimper, KY 41539-6232 - Phone
- (606) 631-3327
- Fax
- (606) 631-3320
- NPI assigned
- Apr 12, 2016
- Organization subpart
- No
Authorized official
- Name
- Robert Lester
- Title
- Owner
- Phone
- (606) 754-0221
Member organizations 1
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2162524 | Kimper Pharmacy | Certificate of waiver | Feb 24, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kimper Pharmacy Inc |
Nebulizer Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161006001017 | KY | Part B Supplier - Mass Immunization (Roster Biller Only) | 1254629249 | Practice locations: Kimper, KY |
| O20161021001772 | KY | DME Supplier - Pharmacy | 1254629249 | Practice locations: Kimper, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | P07766 | KY | Yes |
Addresses
Primary practice location
9711 State Highway 194 E
Kimper, KY 41539-6232
Mailing address
PO Box 532
Elkhorn City, KY 41522-0532
Phone (606) 424-8203
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2159484 | Other | PK | |
| 7100408890 | Medicaid | KY |
Other names
- Kimper Pharmacy
Other providers in Kimper, KY
- Arlene F Chapman
- Lisa Jo Justice
- Kentucky HC LLC
- People First Case Management Services, LLC
- Katelyn Pinion
- Brandy Thacker
- Stacie L Weddington
- Rebecca A. Williamson
All providers in Kimper, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.