Provider Demographics
NPI:1063014645
Name:SHIMEK, KEVIN JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:SHIMEK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13795 ALACIA CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7091
Mailing Address - Country:US
Mailing Address - Phone:979-436-6578
Mailing Address - Fax:
Practice Address - Street 1:475 STATE HIGHWAY 36 N
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-7552
Practice Address - Country:US
Practice Address - Phone:979-567-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist