Provider Demographics
NPI:1073200747
Name:KINGDOM, KMEONE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KMEONE
Middle Name:
Last Name:KINGDOM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 HIGHWAY 1 S # 182
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7355
Mailing Address - Country:US
Mailing Address - Phone:662-332-9955
Mailing Address - Fax:
Practice Address - Street 1:1831 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7355
Practice Address - Country:US
Practice Address - Phone:662-332-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist