Provider Demographics
NPI:1053322545
Name:KOHLER HOMECARE PHARMACY, INC.
Entity Type:Organization
Organization Name:KOHLER HOMECARE PHARMACY, INC.
Other - Org Name:WEBB-KOHLER PHARMACY, HOME MEDICAL EQUIPMENT AND SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVANT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-861-4631
Mailing Address - Street 1:2204 PARK SPRINGS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5642
Mailing Address - Country:US
Mailing Address - Phone:817-861-4631
Mailing Address - Fax:620-508-2755
Practice Address - Street 1:2204 PARK SPRINGS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5642
Practice Address - Country:US
Practice Address - Phone:817-861-4631
Practice Address - Fax:620-508-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 332B00000X
TX193673336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149554Medicaid
TX161601301Medicaid
2104142OtherPK
TX815747831OtherBCBSTX