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General NPI Number Information
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NPI Number | 1245357706
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Entity Type | Organization
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Legal Business Name | WEST KINGMAN PHARMACY, LLC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 3135 N STOCKTON HILL RD
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City | KINGMAN
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State | AZ
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Zip | 86401
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Country | US
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Telephone | 928-377-1350
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Fax |
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Provider Business Mailing Address
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Address Line | 1099 SUNRISE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-6825
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Country | US
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Telephone | 928-718-4852
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Fax | 928-718-4856
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | KASSIE LYNN VILLA
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Credential | CPHT
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Telephone | 928-377-1350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 4696
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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