Provider Demographics
NPI:1073629044
Name:KINNON, ALFREDA LESHIA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ALFREDA
Middle Name:LESHIA
Last Name:KINNON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 LATCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4272
Mailing Address - Country:US
Mailing Address - Phone:770-827-4912
Mailing Address - Fax:404-728-7785
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:ATTN: PHARMACY SERVICES (119)
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist