Organization
KINGMAN HOMETOWN PHARMACY LLC
Active
Parent organization
KINGMAN HOMETOWN PHARMACY LLC
Other names
KINGMAN HOMETOWN PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
KINGMAN HOMETOWN PHARMACY LLC
Authorized official
JENNIFER VELEZ (MGR)
(928) 681-4888
Entity
Organization
Contact information
Practice address
2370 NORTHERN AVE STE A, KINGMAN, AZ 86409-2573
(928) 681-4888
(928) 681-4534
Mailing address
2370 NORTHERN AVE STE A, KINGMAN, AZ 86409-2573
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
4304
AZ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0352992
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/10/2006
Last updated
07/21/2008
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