Healthcare Provider Details

I. General information

NPI: 1932725033
Provider Name (Legal Business Name): KILGORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N PROVIDENCE RD
COLUMBIA MO
65203-4373
US

IV. Provider business mailing address

700 N PROVIDENCE RD
COLUMBIA MO
65203-4373
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-0194
  • Fax:
Mailing address:
  • Phone: 573-442-0194
  • Fax:

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: WILLIAM MORRISSEY
Title or Position: PRESIDENT
Credential:
Phone: 573-442-0914