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General NPI Number Information
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NPI Number | 1053944181
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Entity Type | Organization
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Legal Business Name | KC PLLC
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 204 HIGHWAY 52 BYP W
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City | LAFAYETTE
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State | TN
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Zip | 37083-1727
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Country | US
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Telephone | 270-622-8855
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 295
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City | LAFAYETTE
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State | TN
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Zip | 37083-0295
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Country | US
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Telephone | 270-622-8855
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Fax |
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Authorized Official
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Title or Position | PHARMACY OWNER
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Name | MRS. ELIZABETH ANN KEOWN
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Credential | R.PH.
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Telephone | 270-622-8855
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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 |
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License Number State |
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