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General NPI Number Information
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NPI Number | 1104933381
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Entity Type | Organization
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Legal Business Name | KPH HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 20 FORGHAM ST
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City | LYONS
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State | NY
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Zip | 14489-1308
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Country | US
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Telephone | 315-946-6699
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Fax | 315-946-9499
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Provider Business Mailing Address
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Address Line | 29 E MAIN ST
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City | GOUVERNEUR
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State | NY
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Zip | 13642-1401
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Country | US
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Telephone | 315-287-3600
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Fax | 315-287-4291
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Authorized Official
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Title or Position | THIRD PARTY ADMINISTRATOR
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Name | ELIZABETH M MARLOW
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Credential |
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Telephone | 315-287-3600
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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 | 026466
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License Number State | NY
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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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