Organization
KILGORE EXPRESS PHARMACY INC
Active
Other names
KILGORE EXPRESS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LOTHA KILGORE RPH. (OWNER)
(256) 845-6640
Entity
Organization
Contact information
Practice address
103 GREENHILL BLVD NW, FORT PAYNE, AL 35967-3701
(256) 845-6640
(256) 845-9796
Mailing address
PO BOX 680905, FORT PAYNE, AL 35968-1610
(256) 845-6640
(256) 845-9796
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
112680
AL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009935092
—
AL
05
—
100003635
—
AL
01
—
1995543
PK
—
Enumeration date
09/21/2006
Last updated
12/24/2019
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