Healthcare Provider Details

I. General information

NPI: 1538948211
Provider Name (Legal Business Name): UPTOWN PHARMACY OF KINGMAN , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 E ANDY DEVINE AVE
KINGMAN AZ
86401-4203
US

IV. Provider business mailing address

2820 E ANDY DEVINE AVE
KINGMAN AZ
86401-4203
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-2226
  • Fax: 928-753-7649
Mailing address:
  • Phone: 928-753-2226
  • Fax: 928-753-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRIS PROFFIT
Title or Position: OWNER
Credential:
Phone: 928-753-2226