Healthcare Provider Details

I. General information

NPI: 1407747157
Provider Name (Legal Business Name): KPH HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CANAL ST STE 3
BRATTLEBORO VT
05301-3421
US

IV. Provider business mailing address

29 E MAIN ST
GOUVERNEUR NY
13642-1401
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-4204
  • Fax: 802-257-4766
Mailing address:
  • Phone: 315-287-3600
  • Fax: 315-477-3241

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 Number
License Number State

VIII. Authorized Official

Name: DEBRA V BARBER
Title or Position: VP OF MANAGED CARE CONTRACTING
Credential:
Phone: 315-413-7800