Healthcare Provider Details

I. General information

NPI: 1427503994
Provider Name (Legal Business Name): K & D PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E SCREVEN ST
QUITMAN GA
31643-2178
US

IV. Provider business mailing address

302 E SCREVEN ST
QUITMAN GA
31643-2178
US

V. Phone/Fax

Practice location:
  • Phone: 229-263-4061
  • Fax: 229-263-5950
Mailing address:
  • Phone: 229-263-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE009745
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPHRE009745
License Number StateGA

VIII. Authorized Official

Name: KASEY KNIGHT
Title or Position: OWNER
Credential:
Phone: 229-263-4061