Provider Demographics
NPI:1073674149
Name:KS PHARM LLC
Entity Type:Organization
Organization Name:KS PHARM LLC
Other - Org Name:KELSEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-442-5251
Mailing Address - Street 1:5001 E. SAM HOUSTON PKWY S.
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505
Mailing Address - Country:US
Mailing Address - Phone:713-442-7179
Mailing Address - Fax:713-442-7120
Practice Address - Street 1:5001 E. SAM HOUSTON PKWY S.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:713-442-7179
Practice Address - Fax:713-442-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX195793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470968Medicaid
4576255OtherOTHER ID NUMBER-COMMERCIAL NUMBER