Provider Demographics
NPI:1588799506
Name:KATHY MCLEOD
Entity type:Organization
Organization Name:KATHY MCLEOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-567-2393
Mailing Address - Street 1:362 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-5222
Mailing Address - Country:US
Mailing Address - Phone:229-567-2393
Mailing Address - Fax:229-567-3603
Practice Address - Street 1:362 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-5222
Practice Address - Country:US
Practice Address - Phone:229-567-2393
Practice Address - Fax:229-567-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0032973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000033822AMedicaid
GA000033822AMedicaid