=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891686549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KPH HEALTHCARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 SPRINGFIELD PLAZA RD
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05156-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-885-5311
-----------------------------------------------------
Fax | 802-885-9330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 E MAIN ST
-----------------------------------------------------
City | GOUVERNEUR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13642-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-287-3600
-----------------------------------------------------
Fax | 315-477-3241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF MANAGED CARE CONTRACTING
-----------------------------------------------------
Name | DEBRA V BARBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-413-7800
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------