Provider Demographics
NPI:1366057739
Name:KIMMEL, JENNY LYN (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYN
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EDWIN MILLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-3702
Mailing Address - Country:US
Mailing Address - Phone:304-263-4951
Mailing Address - Fax:
Practice Address - Street 1:1200 EDWIN MILLER BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3702
Practice Address - Country:US
Practice Address - Phone:304-263-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0007244OtherWEST VIRGINIA BOARD OF PHARMACY