Organization
KPH HEALTHCARE SERVICES, INC.
Active
Other names
Kinney Drugs #104
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
(315) 287-3600
Entity
Organization
Contact information
Practice address
161 CAREY ROAD, QUEENSBURY, NY 12804
(518) 480-0011
(518) 792-0598
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
031070
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3419445
—
NY
01
—
J300054748
MEDCIARE NSC IMMUNIZATION BILLING
NY
Enumeration date
12/27/2011
Last updated
07/04/2024
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