Provider Demographics
NPI:1427503994
Name:K & D PHARMACY
Entity type:Organization
Organization Name:K & D PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-263-4061
Mailing Address - Street 1:302 E SCREVEN ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-2178
Mailing Address - Country:US
Mailing Address - Phone:229-263-4061
Mailing Address - Fax:
Practice Address - Street 1:302 E SCREVEN ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-2178
Practice Address - Country:US
Practice Address - Phone:229-263-4061
Practice Address - Fax:229-263-5950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K & D PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009745332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003169273AMedicaid
GA6686300001Medicare NSC