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General NPI Number Information
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NPI Number | 1730415142
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Entity Type | Organization
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Legal Business Name | KILGORE EXPRESS PHARMACY INC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 1614 GLENN BLVD SW
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City | FORT PAYNE
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State | AL
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Zip | 35968-3522
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Country | US
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Telephone | 256-845-3402
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Fax | 256-845-3289
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Provider Business Mailing Address
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Address Line | PO BOX 680905
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City | FORT PAYNE
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State | AL
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Zip | 35968-1610
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Country | US
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Telephone | 256-845-6640
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Fax | 256-845-9796
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | LOTHA KILGORE
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Credential |
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Telephone | 256-845-3402
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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 | 113311
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License Number State | AL
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