Healthcare Provider Details

I. General information

NPI: 1033191234
Provider Name (Legal Business Name): KINGSTON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 NORTH MAIN P.O. BX 548
KINGSTON OK
73439-0548
US

IV. Provider business mailing address

7 NORTH MAIN PO BOX 548
KINGSTON OK
73439-0548
US

V. Phone/Fax

Practice location:
  • Phone: 580-564-2337
  • Fax: 580-564-2331
Mailing address:
  • Phone: 580-564-2337
  • Fax: 580-564-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number683875
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ARRASH ASGARI
Title or Position: OWNER/MANAGER
Credential: PHARM.D.
Phone: 580-564-2337