Healthcare Provider Details

I. General information

NPI: 1356506414
Provider Name (Legal Business Name): KIM GRIFFIN ADCOCK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5208
  • Fax: 601-815-9479
Mailing address:
  • Phone: 601-984-5208
  • Fax: 601-815-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE08994
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: