Provider Demographics
NPI:1982764114
Name:KIRBY & COMPANY PHARMACY LLC
Entity Type:Organization
Organization Name:KIRBY & COMPANY PHARMACY LLC
Other - Org Name:KIRBY AND COMPANY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:386-496-8099
Mailing Address - Street 1:395 W MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-1642
Mailing Address - Country:US
Mailing Address - Phone:386-496-8099
Mailing Address - Fax:386-496-3796
Practice Address - Street 1:395 W MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1642
Practice Address - Country:US
Practice Address - Phone:386-496-8099
Practice Address - Fax:386-496-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH215063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005182OtherPK
FL031042500Medicaid