Provider Demographics
NPI:1508292103
Name:K & Y PHARMACY, LLC
Entity Type:Organization
Organization Name:K & Y PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADEGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-989-1332
Mailing Address - Street 1:969 WINDY HILL RD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2040
Mailing Address - Country:US
Mailing Address - Phone:770-989-1332
Mailing Address - Fax:770-989-1336
Practice Address - Street 1:969 WINDY HILL RD SE
Practice Address - Street 2:SUITE A
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2040
Practice Address - Country:US
Practice Address - Phone:770-989-1332
Practice Address - Fax:770-989-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy