MEDICARE: KB EMPIRE LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1114303781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KB EMPIRE LLC.

Provider Business Mailing Address
First Line	:	11003 ANTOINE DR
Second Line	:	SUITE F
City	:	HOUSTON
State	:	TX
Zip	:	77086-1426
Country	:	US
Telephone Number	:	281-444-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	11003 ANTOINE DR
Second Line	:	STE. F
City	:	HOUSTON
State	:	TX
Zip	:	77086-1426
Country	:	US
Telephone Number	:	281-444-5200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY BREW
Credential	:
Telephone Number	:	281-444-5200

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	03/08/2017

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