# KILGORE EXPRESS PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KILGORE EXPRESS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609974633
- **Authorized official:** LOTHA KILGORE RPH. (OWNER)
- **Authorized official phone:** (256) 845-6640

## Contact information

- **Practice address:** 103 GREENHILL BLVD NW, FORT PAYNE, AL 35967-3701
- **Practice address phone:** (256) 845-6640
- **Practice address fax:** (256) 845-9796
- **Mailing address:** PO BOX 680905, FORT PAYNE, AL 35968-1610
- **Mailing address phone:** (256) 845-6640
- **Mailing address fax:** (256) 845-9796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 112680 | AL | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 12/24/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 009935092 | — | AL |
| 05 | — | 100003635 | — | AL |
| 01 | — | 1995543 | PK | — |