=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902370455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN KILGORE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2019
-----------------------------------------------------
Last Update Date | 11/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 E GLENN AVE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36830-5099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-887-7043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2229 WESTWOOD DR
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36250-5370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 21907
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------