=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770659435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KVM PHARMACY SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 S COMMERCIAL ST
-----------------------------------------------------
City | GOLIAD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77963-4189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-645-3261
-----------------------------------------------------
Fax | 361-645-3281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 S COMMERCIAL ST
-----------------------------------------------------
City | GOLIAD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77963-1227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-645-3261
-----------------------------------------------------
Fax | 361-645-3281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | SRINIVASU VATTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 409-767-6197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 13458
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------