Organization
KIMPAM, INC. DBA. THE MEDICINE SHOPPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK HAROLD MCCLANAHAN JR. RPH. (OWNER)
(770) 787-5698
Entity
Organization
Contact information
Practice address
2155 PACE ST, COVINGTON, GA 30014-6652
(770) 787-5698
(770) 786-3590
Mailing address
2155 PACE ST, COVINGTON, GA 30014-6652
(770) 787-5698
(770) 786-3590
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH011326
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00363415A
—
GA
Enumeration date
12/26/2006
Last updated
08/22/2020
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