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Organization
KILGORE EXPRESS PHARMACY INC
Active
Organization
KILGORE EXPRESS PHARMACY INC
Active
Other names
North Jackson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LOTHA LEE KILGORE (OWNER)
(256) 845-6640
Entity
Organization
Contact information
Practice address
85 BANK ST, STEVENSON, AL 35772-3781
(256) 437-2248
(256) 437-9003
Mailing address
PO BOX 680905, FORT PAYNE, AL 35968-1610
(256) 437-2248
(256) 437-9003
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
107218
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002584
—
AL
01
—
1992953
PK
—
Enumeration date
07/28/2006
Last updated
12/31/2019
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