Provider Demographics
NPI:1427128503
Name:KEMPS PHARMACY INC
Entity type:Organization
Organization Name:KEMPS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-739-2745
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-0097
Mailing Address - Country:US
Mailing Address - Phone:912-739-2745
Mailing Address - Fax:
Practice Address - Street 1:107 S DUVAL ST
Practice Address - Street 2:STE A
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-2029
Practice Address - Country:US
Practice Address - Phone:912-739-2745
Practice Address - Fax:912-739-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
GAPHRE0023983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012110OtherPK
GA00054755AMedicaid
2012110OtherPK