Provider Demographics
NPI:1053986711
Name:KIMBRELL, CALINA THEREAS
Entity type:Individual
Prefix:
First Name:CALINA
Middle Name:THEREAS
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MAXWELL LN
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:AL
Mailing Address - Zip Code:35554-3247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31040 1ST AVE NE STE 5
Practice Address - Street 2:
Practice Address - City:CARBON HILL
Practice Address - State:AL
Practice Address - Zip Code:35549-4152
Practice Address - Country:US
Practice Address - Phone:205-924-9616
Practice Address - Fax:205-924-9767
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT48596183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician