Organization
KLH ENTERPRISES, INC.
Active
Other names
St. Mary's Road Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH LYDELL HARRELL (PRESIDENT)
(706) 685-1845
Entity
Organization
Contact information
Practice address
111 N OAKLEY DR, COLUMBUS, GA 31906-4476
(706) 685-1845
(706) 685-9066
Mailing address
111 N OAKLEY DR, COLUMBUS, GA 31906-4476
(706) 685-1845
(706) 685-9066
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008778
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265721575A
—
GA
Enumeration date
12/28/2006
Last updated
09/16/2010
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