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General NPI Number Information
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NPI Number | 1942348677
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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 | 02/02/2007
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 2820 E ANDY DEVINE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-4203
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Country | US
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Telephone | 928-753-2738
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Fax | 928-753-2383
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Provider Business Mailing Address
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Address Line | 2820 E ANDY DEVINE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-4203
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Country | US
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Telephone | 928-753-2738
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Fax | 928-753-2383
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Authorized Official
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Title or Position | PHARMACISTIS, PRESIDENT
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Name | MR. CHRIS HOWARD PROFFIT
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Credential | RPH
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Telephone | 928-753-2738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | Y007029
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License Number State | AZ
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