MEDICARE: KPM SPECIALTY HOLDINGS INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336M0003X	Managed Care Organization Pharmacy
3	3336S0011X	Specialty Pharmacy	PW0376	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2137203	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1669714267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KPM SPECIALTY HOLDINGS INC

Provider Business Mailing Address
First Line	:	8700 CENTRAL AVE STE 301
Second Line	:	OMNI MEDICAL BLDG
City	:	LANDOVER
State	:	MD
Zip	:	20785-4853
Country	:	US
Telephone Number	:	240-619-3407
Fax Number	:	202-318-0440

Provider Business Practice Location Address
First Line	:	8700 CENTRAL AVE STE 301
Second Line	:	OMNI MEDICAL BLDG
City	:	LANDOVER
State	:	MD
Zip	:	20785-4853
Country	:	US
Telephone Number	:	240-619-3407
Fax Number	:	202-318-0440

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	ANTONIO TOMLINSON
Credential	:
Telephone Number	:	240-619-3407

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/21/2013

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Directions to “KPM SPECIALTY HOLDINGS INC ” Practice Location

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