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General NPI Number Information
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NPI Number | 1073067278
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Entity Type | Organization
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Legal Business Name | KMART PHARMACY
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 161 BIG ELK MALL
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City | ELKTON
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State | MD
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Zip | 21921-5912
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Country | US
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Telephone | 410-392-6315
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Fax |
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Provider Business Mailing Address
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Address Line | 161 BIG ELK MALL
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City | ELKTON
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State | MD
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Zip | 21921-5912
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Country | US
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Telephone | 410-392-6315
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Fax |
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | DEEPAK KINI
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Credential |
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Telephone | 847-396-2040
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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 | 24332
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License Number State | MD
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