Organization
THE KG GROUP LLC
Active
Other names
Shadow Creek Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KWAME ALBERT (OWNER)
(832) 617-8080
Entity
Organization
Contact information
Practice address
11710 BROADWAY ST STE 120, PEARLAND, TX 77584-4046
(832) 617-8080
(832) 717-2391
Mailing address
11408 EASTON SPRINGS DR, PEARLAND, TX 77584-2518
(281) 303-7551
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176871
PK
—
Enumeration date
03/28/2018
Last updated
05/21/2019
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