Healthcare Provider Details

I. General information

NPI: 1700968583
Provider Name (Legal Business Name): KILLION'S PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 W TEXAS AVE
WASKOM TX
75692-9113
US

IV. Provider business mailing address

PO BOX 687
WASKOM TX
75692-0687
US

V. Phone/Fax

Practice location:
  • Phone: 903-687-2525
  • Fax: 903-687-2526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01734
License Number StateTX

VIII. Authorized Official

Name: ROSA RIVAS
Title or Position: OWNER/PIC
Credential:
Phone: 903-687-2525