Provider Demographics
NPI:1932273307
Name:KEMPS PHARMACY INC
Entity Type:Organization
Organization Name:KEMPS PHARMACY INC
Other - Org Name:REIDSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-557-4000
Mailing Address - Street 1:246 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453-4663
Mailing Address - Country:US
Mailing Address - Phone:912-557-4000
Mailing Address - Fax:912-557-4080
Practice Address - Street 1:246 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-4663
Practice Address - Country:US
Practice Address - Phone:912-557-4000
Practice Address - Fax:912-557-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
GAPHRE0086363336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00054755CMedicaid
2014615OtherPK
5284820002Medicare NSC