Organization
KILGORE EXPRESS PHARMACY INC
Active
Other names
Kilgore Express Pharmacy #6
Organization subpart
No
Provider details
NPI number
Authorized official
LOTHA KILGORE (PHARMACIST/OWNER)
(256) 845-3402
Entity
Organization
Contact information
Practice address
1614 GLENN BLVD SW, FORT PAYNE, AL 35968-3522
(256) 845-3402
(256) 845-3289
Mailing address
PO BOX 680905, FORT PAYNE, AL 35968-1610
(256) 845-6640
(256) 845-9796
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
113311
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0136209
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/20/2009
Last updated
10/20/2009
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