Organization
KPH HEALTHCARE SERVICES, INC.
Active
Other names
Kinney Drugs #74
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M MARLOW (THIRD PARTY ADMINISTRATOR)
(315) 287-3600
Entity
Organization
Contact information
Practice address
596 ROUTE 11, TULLY, NY 13159
(315) 696-8796
(315) 696-6145
Mailing address
29 E MAIN ST, GOUVERNEUR, NY 13642-1401
(315) 287-3600
(315) 287-4291
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
026934
NY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02620419
—
NY
01
—
3340255
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/24/2006
Last updated
07/04/2024
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