Healthcare Provider Details

I. General information

NPI: 1508202888
Provider Name (Legal Business Name): KILGORE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 B EASTSIDE DR
ASHLAND MO
65010
US

IV. Provider business mailing address

700 N PROVIDENCE RD
COLUMBIA MO
65203-4373
US

V. Phone/Fax

Practice location:
  • Phone: 573-657-3333
  • Fax: 573-657-7022
Mailing address:
  • Phone: 573-442-0194
  • Fax: 573-443-8253

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM ARNOLD MORRISSEY
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 573-442-0194