# KILGORE EXPRESS PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kilgore Express Pharmacy \#6
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730415142
- **Authorized official:** LOTHA KILGORE (PHARMACIST/OWNER)
- **Authorized official phone:** (256) 845-3402

## Contact information

- **Practice address:** 1614 GLENN BLVD SW, FORT PAYNE, AL 35968-3522
- **Practice address phone:** (256) 845-3402
- **Practice address fax:** (256) 845-3289
- **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 |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 113311 | AL | Yes |

## Other

- **Enumeration date:** 10/20/2009
- **Last updated:** 10/20/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0136209 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |