Healthcare Provider Details

I. General information

NPI: 1104962695
Provider Name (Legal Business Name): K & P PHARMACY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 4TH AVE NE
CULLMAN AL
35055
US

IV. Provider business mailing address

209 4TH AVE NE
CULLMAN AL
35055
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-6013
  • Fax: 256-734-6458
Mailing address:
  • Phone: 256-734-6013
  • Fax: 256-734-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number105290
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1988252
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier10000074
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 3
Identifier100000704A
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name: KIAH BROWN
Title or Position: OWNER/MEMBER
Credential: RPH
Phone: 256-734-6013