Provider Demographics
NPI:1255346896
Name:KILMICHAEL DRUGS INC
Entity type:Organization
Organization Name:KILMICHAEL DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHCY MNGR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-262-4387
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:KILMICHAEL
Mailing Address - State:MS
Mailing Address - Zip Code:39747-0213
Mailing Address - Country:US
Mailing Address - Phone:662-262-4387
Mailing Address - Fax:662-262-4397
Practice Address - Street 1:306 LAMAR AVE.
Practice Address - Street 2:
Practice Address - City:KILMICHAEL
Practice Address - State:MS
Practice Address - Zip Code:39747-9732
Practice Address - Country:US
Practice Address - Phone:662-262-4220
Practice Address - Fax:662-262-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS002250113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330197Medicaid
2504961OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2504961OtherNCPDP PROVIDER IDENTIFICATION NUMBER