Provider Demographics
NPI:1447247945
Name:K & D PHARMACY
Entity type:Organization
Organization Name:K & D PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-625-8030
Mailing Address - Street 1:5838 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2963
Mailing Address - Country:US
Mailing Address - Phone:248-625-8030
Mailing Address - Fax:248-625-9207
Practice Address - Street 1:5838 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2963
Practice Address - Country:US
Practice Address - Phone:248-625-8030
Practice Address - Fax:248-625-9207
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K & D PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-30
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON54000OtherMEDICARE PART B
MI2327496Medicaid
4180030001Medicare NSC