Kimpam, Inc. Dba. the Medicine Shoppe

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH011326 Issued in GA

Legal business name

KIMPAM, INC. DBA. THE MEDICINE SHOPPE

Practice address

2155 Pace St
Covington, GA 30014-6652

Phone

(770) 787-5698

Fax

(770) 786-3590

NPI assigned

Dec 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jack Harold McClanahan Jr., RPH.

Title

Owner

Phone

(770) 787-5698

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801951272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 PACE ST",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300146652",
            "telephone_number": "770-787-5698",
            "fax_number": "770-786-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 PACE ST",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300146652",
            "telephone_number": "770-787-5698",
            "fax_number": "770-786-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMPAM, INC. DBA. THE MEDICINE SHOPPE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCLANAHAN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-787-5698",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH011326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00363415A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Covington, GA
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• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.