# KPH HEALTHCARE SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kinney Drugs \#94
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215135702
- **Authorized official:** ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
- **Authorized official phone:** (315) 287-3600

## Contact information

- **Practice address:** 407 BROAD ST, LYNDONVILLE, VT 05851-5600
- **Practice address phone:** (802) 626-3779
- **Practice address fax:** (802) 626-1089
- **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 | 0380003357 | VT | Yes |

## Other

- **Enumeration date:** 07/05/2007
- **Last updated:** 07/03/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1013842 | — | VT |
| 01 | — | 4704210 | NCPDP | VT |