Organization
KILGORE EXPRESS PHARMACY INC
Active
Other names
North Jackson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LOTHA LEE KILGORE (OWNER)
(256) 845-6640
Entity
Organization
Contact information
Practice address
85 BANK ST, STEVENSON, AL 35772-3781
(256) 437-2248
(256) 437-9003
Mailing address
PO BOX 680905, FORT PAYNE, AL 35968-1610
(256) 437-2248
(256) 437-9003
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
107218
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002584
—
AL
01
—
1992953
PK
—
Enumeration date
07/28/2006
Last updated
12/31/2019
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