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General NPI Number Information
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NPI Number | 1912918582
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Entity Type | Organization
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Legal Business Name | UPTOWN PHARMACY OF KINGMAN , INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 4495 N BANK ST STE 1
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City | KINGMAN
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State | AZ
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Zip | 86409-2711
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Country | US
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Telephone | 928-757-1131
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Fax | 928-757-1108
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Provider Business Mailing Address
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Address Line | 4495 N BANK ST STE 1
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City | KINGMAN
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State | AZ
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Zip | 86409-2711
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Country | US
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Telephone | 928-757-1131
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Fax | 928-757-1108
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Authorized Official
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Title or Position | OWNER
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Name | CHRIS HOWARD PROFFIT
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Credential | B. S. PHARMACY
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Telephone | 928-757-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | Y007032
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y007032
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License Number State | AZ
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