Healthcare Provider Details

I. General information

NPI: 1982764114
Provider Name (Legal Business Name): KIRBY & COMPANY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W MAIN ST STE C
LAKE BUTLER FL
32054-1642
US

IV. Provider business mailing address

395 W MAIN ST STE C
LAKE BUTLER FL
32054-1642
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-8099
  • Fax: 386-496-3796
Mailing address:
  • Phone: 386-496-8099
  • Fax: 386-496-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21506
License Number StateFL

VIII. Authorized Official

Name: KEVIN KIRBY
Title or Position: PHARM
Credential: PHARM D
Phone: 386-496-8099