Organization
KILGORE INC
Active
Other names
KILGORE'S MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANN BROMSTEDT (OWNER)
(573) 442-0194
Entity
Organization
Contact information
Practice address
700 N PROVIDENCE RD, COLUMBIA, MO 65203-4373
(573) 442-0194
(573) 443-8253
Mailing address
700 N PROVIDENCE RD, COLUMBIA, MO 65203-4373
(573) 442-0194
(573) 443-8253
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2008000930
MO
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2047047
PK
—
05
—
600587205
—
MO
05
—
600587208
—
MO
05
—
620587204
—
MO
05
—
850587205
—
MO
Enumeration date
05/20/2006
Last updated
01/21/2016
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