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Organization
KILGORE EXPRESS PHARMACY INC
Active
Organization
KILGORE EXPRESS PHARMACY INC
Active
Other names
KILGORE EXPRESS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LOTHA KILGORE RPH. (OWNER)
(256) 845-6640
Entity
Organization
Contact information
Practice address
103 GREENHILL BLVD NW, FORT PAYNE, AL 35967-3701
(256) 845-6640
(256) 845-9796
Mailing address
PO BOX 680905, FORT PAYNE, AL 35968-1610
(256) 845-6640
(256) 845-9796
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
112680
AL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009935092
—
AL
05
—
100003635
—
AL
01
—
1995543
PK
—
Enumeration date
09/21/2006
Last updated
12/24/2019
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