Provider Demographics
NPI:1043709785
Name:KINGMAN DRUG INC
Entity Type:Organization
Organization Name:KINGMAN DRUG INC
Other - Org Name:KINGMAN DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLL GEESLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-532-5113
Mailing Address - Street 1:211 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1334
Mailing Address - Country:US
Mailing Address - Phone:620-532-5113
Mailing Address - Fax:620-532-5431
Practice Address - Street 1:211 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1334
Practice Address - Country:US
Practice Address - Phone:620-532-5113
Practice Address - Fax:620-532-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-05357333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080410AMedicaid
2177514OtherPK