Provider Demographics
NPI:1033191234
Name:KINGSTON PHARMACY LLC
Entity Type:Organization
Organization Name:KINGSTON PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARRASH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-564-2337
Mailing Address - Street 1:7 NORTH MAIN
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-0548
Mailing Address - Country:US
Mailing Address - Phone:580-564-2337
Mailing Address - Fax:580-564-2331
Practice Address - Street 1:7 NORTH MAIN
Practice Address - Street 2:P.O. BX 548
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-0548
Practice Address - Country:US
Practice Address - Phone:580-564-2337
Practice Address - Fax:580-564-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK683875183500000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3711985OtherNABP
OK278673OtherIMMY
OK100235770AMedicaid