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General NPI Number Information
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NPI Number | 1225166184
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Entity Type | Organization
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Legal Business Name | KIPA INC. DBA RODGERS FAMILY PHARMACY
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 130 W CENTRAL AVE
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City | PETAL
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State | MS
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Zip | 39465-2314
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Country | US
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Telephone | 601-582-8351
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Fax | 601-545-7342
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Provider Business Mailing Address
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Address Line | 130 W CENTRAL AVE
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City | PETAL
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State | MS
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Zip | 39465-2314
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Country | US
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Telephone | 601-582-8351
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Fax | 601-545-7342
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Authorized Official
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Title or Position | OWNER
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Name | MR. DUKE KIMBRELL RODGERS
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Credential | RPH
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Telephone | 601-582-8351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0219301.1
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License Number State | MS
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