Provider Demographics
NPI:1730681347
Name:VINES, KIM (RPH)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:VINES
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 1:407 BIENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5702
Mailing Address - Country:US
Mailing Address - Phone:877-646-1716
Mailing Address - Fax:
Practice Address - Street 1:407 BIENVILLE ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5702
Practice Address - Country:US
Practice Address - Phone:877-646-1716
Practice Address - Fax:318-214-4190
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist