Amy Marie Mimms, PHARMD
Individual provider Active NPI Pharmacist · St Matthews, KY
NPI 1689279028 · NPPES record last updated Dec 3, 2020
Key facts
- NPI
- 1689279028
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 016218 (KY)
- Practice address
- 143 Thierman LN
St Matthews, KY 40207-5009 - Phone
- (502) 893-8110
- Fax
- (502) 893-8056
- NPI assigned
- Dec 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016218 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past |
Accepting new patients | |
| Wal-Mart Stores East, LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 016218 | KY | Yes |
Addresses
Primary practice location
143 Thierman LN
St Matthews, KY 40207-5009
Mailing address
486 Oak Tree Way
Taylorsville, KY 40071-7184
Phone (501) 758-2744
Other names
- Amy Monroe
Other providers in St Matthews, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.