Provider Demographics
NPI:1366497984
Name:KILMARNOCK DRUG CO INC
Entity Type:Organization
Organization Name:KILMARNOCK DRUG CO INC
Other - Org Name:ANCHOR PHARMACY #112
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:804-435-2186
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:P.O. BOX 1898
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1898
Mailing Address - Country:US
Mailing Address - Phone:804-435-2186
Mailing Address - Fax:844-742-6569
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-2186
Practice Address - Fax:844-742-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010029483336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105483OtherPK
VA009141740Medicaid
VA008505501Medicaid
2105483OtherPK