Provider Demographics
NPI:1235743295
Name:KP AND RD LLC
Entity Type:Organization
Organization Name:KP AND RD LLC
Other - Org Name:WARE SHOALS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYSHRIBEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-906-6108
Mailing Address - Street 1:P.O.BOX: 727
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-9998
Mailing Address - Country:US
Mailing Address - Phone:864-606-0088
Mailing Address - Fax:864-301-8466
Practice Address - Street 1:728 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WARE SHOALS
Practice Address - State:SC
Practice Address - Zip Code:29692-1233
Practice Address - Country:US
Practice Address - Phone:864-606-0088
Practice Address - Fax:864-301-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7Z1110Medicaid