Organization
MALKEN PHARM SERVICES INC
Active
Other names
PEMBROKE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH BRANT KICKLIGHTER PHARMD (PRESIDENT/OWNER)
(912) 653-2772
Entity
Organization
Contact information
Practice address
137 E. BACON ST, PEMBROKE, GA 31321
(912) 653-2772
(912) 653-2752
Mailing address
P.O BOX 1329, PEMBROKE, GA 31321
(912) 653-2772
(912) 653-2752
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PHRE005854
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00143822A
—
GA
01
—
2013956
PK
—
Enumeration date
03/09/2007
Last updated
05/27/2020
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