Organization
KVG ENTERPRISES INC
Active
Other names
Randol Mill LTC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GARY DALEY (OWNER)
(817) 274-1883
Entity
Organization
Contact information
Practice address
1014 A NORTH FIELDER ROAD, ARLINGTON, TX 76015
(817) 274-1883
(817) 274-9621
Mailing address
1014 A NORTH FIELDER ROAD, ARLINGTON, TX 76015
Taxonomy
Speciality
Code
Description
License number
State
332100000X
Department of Veterans Affairs (VA) Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
19543
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4549854
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/06/2008
Last updated
10/16/2008
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