Provider Demographics
NPI:1194837047
Name:K K B CORPORATION
Entity Type:Organization
Organization Name:K K B CORPORATION
Other - Org Name:WALTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-485-7733
Mailing Address - Street 1:305 MARY GRUBBS HWY
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094
Mailing Address - Country:US
Mailing Address - Phone:859-485-7733
Mailing Address - Fax:859-485-2749
Practice Address - Street 1:305 MARY GRUBBS HWY
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-7483
Practice Address - Country:US
Practice Address - Phone:859-485-7733
Practice Address - Fax:859-485-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336M0002X, 3336S0011X, 3336C0004X
KYPO18613336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54009881Medicaid
2029144OtherPK
KY54009881Medicaid