Healthcare Provider Details

I. General information

NPI: 1821679044
Provider Name (Legal Business Name): KINGSLEY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W 2ND ST
KINGSLEY IA
51028-7751
US

IV. Provider business mailing address

7 W 2ND ST
KINGSLEY IA
51028-7751
US

V. Phone/Fax

Practice location:
  • Phone: 712-383-3784
  • Fax: 712-383-3086
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CONNOR CLARK
Title or Position: OWNER
Credential:
Phone: 712-383-3784