Provider Demographics
NPI:1487257101
Name:PENNEY, KIMBERLY JONES (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JONES
Last Name:PENNEY
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:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:DELTAVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23043-1063
Mailing Address - Country:US
Mailing Address - Phone:804-435-1602
Mailing Address - Fax:
Practice Address - Street 1:100 JAMES B JONES MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3908
Practice Address - Country:US
Practice Address - Phone:804-435-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist