Organization
KPH HEALTHCARE SERVICES, INC.
Active
Other names
Kinney Drugs #55
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
(315) 287-3600
Entity
Organization
Contact information
Practice address
1653 WILLISTON RD, SOUTH BURLINGTON, VT 05403-6426
(802) 806-0714
(802) 860-1407
Mailing address
29 E MAIN ST, GOUVERNEUR, NY 13642-1401
(315) 287-3600
(315) 287-4291
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
0380003310
VT
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006757
—
VT
01
—
4703713
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/24/2006
Last updated
07/03/2024
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