Healthcare Provider Details

I. General information

NPI: 1255346896
Provider Name (Legal Business Name): KILMICHAEL DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 LAMAR AVE.
KILMICHAEL MS
39747-9732
US

IV. Provider business mailing address

PO BOX 213
KILMICHAEL MS
39747-0213
US

V. Phone/Fax

Practice location:
  • Phone: 662-262-4220
  • Fax: 662-262-4397
Mailing address:
  • Phone: 662-262-4387
  • Fax: 662-262-4397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00225011
License Number StateMS

VIII. Authorized Official

Name: KENNETH ROBINSON
Title or Position: PHCY MNGR
Credential:
Phone: 662-262-4387