Organization
KPH HEALTHCARE SERVICES, INC.
Active
Other names
Kinney Drugs #92
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
(315) 287-3600
Entity
Organization
Contact information
Practice address
261 UTICA BOULEVARD, BOONVILLE, NY 13309
(315) 978-5466
(315) 978-5467
Mailing address
29 E MAIN ST, GOUVERNEUR, NY 13642-1401
(315) 287-3600
(315) 287-4291
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
028488
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028488
STATE PHARMACY LICENSE
NY
05
—
02886597
—
NY
01
—
3354812
NCPDP
NY
Enumeration date
07/05/2007
Last updated
07/04/2024
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