Provider Demographics
NPI:1316472244
Name:KIMBLE, NICOLE (RPH)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19471 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TRIMBLE
Mailing Address - State:OH
Mailing Address - Zip Code:45782-0158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:965 POPLAR ST
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-1442
Practice Address - Country:US
Practice Address - Phone:740-753-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032279711835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist