Provider Demographics
NPI:1326210345
Name:KCL INCORPORATED
Entity Type:Organization
Organization Name:KCL INCORPORATED
Other - Org Name:LANDRYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-466-1127
Mailing Address - Street 1:25 WOODBRIDGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-1242
Mailing Address - Country:US
Mailing Address - Phone:901-466-1127
Mailing Address - Fax:901-466-1126
Practice Address - Street 1:25 WOODBRIDGE RD STE B
Practice Address - Street 2:STE B
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1242
Practice Address - Country:US
Practice Address - Phone:901-466-1127
Practice Address - Fax:901-466-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN44943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095356OtherPK