Provider Demographics
NPI:1770973406
Name:PRO KIMA, LLC
Entity type:Organization
Organization Name:PRO KIMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-975-0925
Mailing Address - Street 1:1891 N LEE TREVINO DR
Mailing Address - Street 2:# 200
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4127
Mailing Address - Country:US
Mailing Address - Phone:915-629-2020
Mailing Address - Fax:
Practice Address - Street 1:1891 N LEE TREVINO DR STE 200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4132
Practice Address - Country:US
Practice Address - Phone:915-629-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149871OtherPK