Organization
KPH HEALTHCARE SERVICES, INC.
Active
Other names
Kinney Drugs #91
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
(315) 287-3600
Entity
Organization
Contact information
Practice address
48 MAPLE ST, POTSDAM, NY 13676-1124
(315) 262-0529
(315) 265-2990
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
028329
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028329
PHARMACY STATE LICENSE
NY
05
—
02863752
—
NY
Enumeration date
03/20/2007
Last updated
07/04/2024
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