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General NPI Number Information
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NPI Number | 1023398443
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Entity Type | Organization
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Legal Business Name | KB PHARMACY
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 320 S MAIN ST
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City | MARION
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State | KY
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Zip | 42064-1513
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Country | US
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Telephone | 270-967-9007
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Fax |
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Provider Business Mailing Address
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Address Line | 320 S MAIN ST PO BOX 437
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City | MARION
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State | KY
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Zip | 42064-1513
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Country | US
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Telephone | 270-967-9007
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BRADLEY BOONE
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Credential | PHARM D
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Telephone | 270-967-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PO7465
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License Number State | KY
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