Healthcare Provider Details

I. General information

NPI: 1043709785
Provider Name (Legal Business Name): KINGMAN DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N MAIN ST
KINGMAN KS
67068-1334
US

IV. Provider business mailing address

211 N MAIN ST
KINGMAN KS
67068-1334
US

V. Phone/Fax

Practice location:
  • Phone: 620-532-5113
  • Fax: 620-532-5431
Mailing address:
  • Phone: 620-532-5113
  • Fax: 620-532-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2-05357
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CINDA NOLL GEESLING
Title or Position: MANAGER
Credential:
Phone: 620-532-5113