Organization
KILGORE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUWAFEMI ADEGBOYEGA (OWNER)
(708) 945-0269
Entity
Organization
Contact information
Practice address
1909 MAIN ST, HAYNESVILLE, LA 71038-4907
(318) 624-1122
Mailing address
1909 MAIN ST, HAYNESVILLE, LA 71038-4907
(318) 624-1122
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2210017
—
LA
Enumeration date
11/07/2023
Last updated
05/03/2025
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