Provider Demographics
NPI:1225166184
Name:KIPA INC. DBA RODGERS FAMILY PHARMACY
Entity Type:Organization
Organization Name:KIPA INC. DBA RODGERS FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:KIMBRELL
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-582-8351
Mailing Address - Street 1:130 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-2314
Mailing Address - Country:US
Mailing Address - Phone:601-582-8351
Mailing Address - Fax:601-545-7342
Practice Address - Street 1:130 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2314
Practice Address - Country:US
Practice Address - Phone:601-582-8351
Practice Address - Fax:601-545-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0219301.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2516562OtherNCPDP
MS00030167Medicaid