Provider Demographics
NPI:1861097743
Name:KITTRELL, WILLIAM Z JR (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:Z
Last Name:KITTRELL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-1540
Mailing Address - Country:US
Mailing Address - Phone:706-846-1241
Mailing Address - Fax:
Practice Address - Street 1:503 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-1540
Practice Address - Country:US
Practice Address - Phone:706-846-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10408183500000X
GAGA14350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA14350OtherBOARD OF PHARMACY
AL10408OtherAL BOARD OF PHARMACY