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General NPI Number Information
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NPI Number | 1427190776
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Entity Type | Organization
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Legal Business Name | KELSO DRUG CO
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 204 S PACIFIC AVE
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City | KELSO
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State | WA
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Zip | 98626-1618
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Country | US
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Telephone | 360-423-2220
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Fax | 360-425-1940
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | KELSO
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State | WA
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Zip | 98626-0002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES HOLLINGSWORTH
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Credential |
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Telephone | 360-423-2220
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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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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | CF00002494
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License Number State | WA
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