Provider Demographics
NPI:1083721260
Name:KINNEY DRUGS INC
Entity Type:Organization
Organization Name:KINNEY DRUGS INC
Other - Org Name:KINNEY DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY COORDNTR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-552-8663
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-0398
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:62 STATION RD
Practice Address - Street 2:
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996
Practice Address - Country:US
Practice Address - Phone:518-963-8946
Practice Address - Fax:518-963-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027350333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3343883OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY02664597Medicaid