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Organization
KPH HEALTHCARE SERVICES, INC.
Active
Organization
KPH HEALTHCARE SERVICES, INC.
Active
Other names
Kinney Drugs #56
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
(315) 287-3600
Entity
Organization
Contact information
Practice address
901 LOWER PLN, BRADFORD, VT 05033-8924
(802) 222-9292
(802) 222-5549
Mailing address
29 E MAIN ST, GOUVERNEUR, NY 13642-1401
(315) 287-3600
(315) 287-4291
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
0380003311
VT
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006754
—
VT
01
—
4703725
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
K11006754
—
VT
Enumeration date
08/24/2006
Last updated
07/03/2024
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