Organization
KILGORE EXPRESS PHARMCY INC
Active
Other names
KILGORE EXPRESS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LOTHA KILGORE RPH (OWNER)
(256) 845-6640
Entity
Organization
Contact information
Practice address
588 S VALLEY AVE, COLLINSVILLE, AL 35961-3535
(256) 524-2981
(256) 524-2987
Mailing address
PO BOX 680905, FORT PAYNE, AL 35968-1610
(256) 845-6640
(256) 845-9796
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
112980
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0134700
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/22/2007
Last updated
05/23/2011
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