# KPH HEALTHCARE SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kinney Drugs \#105
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013203074
- **Authorized official:** ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
- **Authorized official phone:** (315) 287-3600

## Contact information

- **Practice address:** 16 CHURCH ST, BARTON, VT 05822-8511
- **Practice address phone:** (802) 525-4098
- **Practice address fax:** (802) 525-3794
- **Mailing address:** 29 E MAIN ST, GOUVERNEUR, NY 13642-1401
- **Mailing address phone:** (315) 287-3600
- **Mailing address fax:** (315) 287-4291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 0380077454RPPP | VT | Yes |

## Other

- **Enumeration date:** 06/28/2011
- **Last updated:** 07/03/2024