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General NPI Number Information
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NPI Number | 1568831071
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Entity Type | Organization
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Legal Business Name | 2-K PHARMAKON SERVICES LLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 507 S RAILROAD AVE
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City | TWIN CITY
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State | GA
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Zip | 30471
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Country | US
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Telephone | 478-763-2151
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Fax | 478-763-3833
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Provider Business Mailing Address
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Address Line | PO BOX 1040
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City | TWIN CITY
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State | GA
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Zip | 30471-1040
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Country | US
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Telephone | 478-763-2151
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Fax | 478-763-3833
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. KENNETH BRANT KICKLIGHTER JR.
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Credential | PHARMD.
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Telephone | 478-763-2151
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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 | PHRE010173
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License Number State | GA
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