Provider Demographics
NPI:1073036570
Name:KB PHARMACY LLC
Entity Type:Organization
Organization Name:KB PHARMACY LLC
Other - Org Name:KINGSWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:CHINAGO
Authorized Official - Last Name:OZIOKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-418-6915
Mailing Address - Street 1:2005 JAYDEN LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 JAYDEN LN
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6031
Practice Address - Country:US
Practice Address - Phone:469-418-6915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy