Healthcare Provider Details

I. General information

NPI: 1912912528
Provider Name (Legal Business Name): KILLEN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 HIGHWAY 72
KILLEN AL
35645-9101
US

IV. Provider business mailing address

PO BOX 1285
KILLEN AL
35645-1285
US

V. Phone/Fax

Practice location:
  • Phone: 256-757-1161
  • Fax: 256-757-1132
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112748
License Number StateAL

VIII. Authorized Official

Name: KIM BLANKINSHIP
Title or Position: PRESIDENT
Credential: RPH
Phone: 256-229-5550