Provider Demographics
NPI:1508863903
Name:KDK, INC
Entity Type:Organization
Organization Name:KDK, INC
Other - Org Name:ASHLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GEERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-657-2600
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:113 E BROADWAY
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-0348
Mailing Address - Country:US
Mailing Address - Phone:573-657-2600
Mailing Address - Fax:573-657-2927
Practice Address - Street 1:113 E BROADWAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-9301
Practice Address - Country:US
Practice Address - Phone:573-657-2600
Practice Address - Fax:573-657-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO PH005676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2629218OtherNCPDP #
MO603177007Medicaid
MO623177003Medicaid
MO2629218OtherNCPDP #