Organization
WEST KINGMAN PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KASSIE LYNN VILLA CPHT (PHARMACY MANAGER)
(928) 377-1350
Entity
Organization
Contact information
Practice address
3135 N STOCKTON HILL RD, KINGMAN, AZ 86401
(928) 718-5418
(928) 718-5419
Mailing address
1099 E SUNRISE AVE, KINGMAN, AZ 86401-6825
(928) 718-5418
(928) 718-5419
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192215
—
AZ
01
—
2151367
PK
—
Enumeration date
04/15/2015
Last updated
08/12/2019
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