Provider Demographics
NPI:1508202888
Name:KILGORE INC.
Entity Type:Organization
Organization Name:KILGORE INC.
Other - Org Name:KILGORE'S MEDICAL PHARMACY ASHLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:573-442-0194
Mailing Address - Street 1:700 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4373
Mailing Address - Country:US
Mailing Address - Phone:573-442-0194
Mailing Address - Fax:573-443-8253
Practice Address - Street 1:109 B EASTSIDE DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010
Practice Address - Country:US
Practice Address - Phone:573-657-3333
Practice Address - Fax:573-657-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0412920003Medicare NSC