Provider Demographics
NPI:1992971386
Name:MITCHELL, KIMBERLY FAITH (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAITH
Last Name:MITCHELL
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 1:100 MALABU DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3159
Mailing Address - Country:US
Mailing Address - Phone:859-278-2087
Mailing Address - Fax:859-278-8558
Practice Address - Street 1:100 MALABU DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3159
Practice Address - Country:US
Practice Address - Phone:859-278-2087
Practice Address - Fax:859-278-8558
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist