Organization
KONGDARA LLC
Active
Organization
KONGDARA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ROGERS (OFFICE ADMINISTRATOR)
(806) 358-2428
Entity
Organization
Contact information
Practice address
5901 BELL ST STE C32, AMARILLO, TX 79109-6231
(806) 358-2428
(806) 353-4463
Mailing address
5901 BELL ST STE C32, AMARILLO, TX 79109-6231
(806) 358-2428
(806) 353-4463
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31655
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1429920-01
—
TX
05
—
1429920-02
—
TX
05
—
144312
—
TX
01
—
4570859
NABP
TX
Enumeration date
08/03/2006
Last updated
01/31/2018
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