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General NPI Number Information
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NPI Number | 1104321371
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Entity Type | Organization
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Legal Business Name | THE KG GROUP LLC
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 11710 BROADWAY ST STE 120
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City | PEARLAND
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State | TX
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Zip | 77584-4046
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Country | US
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Telephone | 832-617-8080
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Fax | 832-717-2391
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Provider Business Mailing Address
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Address Line | 11408 EASTON SPRINGS DR
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City | PEARLAND
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State | TX
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Zip | 77584-2518
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Country | US
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Telephone | 281-303-7551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KWAME ALBERT
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Credential |
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Telephone | 832-617-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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