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General NPI Number Information
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NPI Number | 1679581292
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Entity Type | Organization
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Legal Business Name | KONGDARA LLC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 5901 BELL ST STE C32
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City | AMARILLO
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State | TX
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Zip | 79109-6231
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Country | US
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Telephone | 806-358-2428
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Fax | 806-353-4463
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Provider Business Mailing Address
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Address Line | 5901 BELL ST STE C32
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City | AMARILLO
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State | TX
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Zip | 79109-6231
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Country | US
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Telephone | 806-358-2428
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Fax | 806-353-4463
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | LISA ROGERS
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Credential |
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Telephone | 806-358-2428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31655
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License Number State | TX
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