Provider Demographics
NPI:1518028687
Name:KS PHARM, LLC
Entity Type:Organization
Organization Name:KS PHARM, LLC
Other - Org Name:KELSEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-442-5251
Mailing Address - Street 1:25553 US HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365
Mailing Address - Country:US
Mailing Address - Phone:713-442-2179
Mailing Address - Fax:713-442-2194
Practice Address - Street 1:25553 US HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365
Practice Address - Country:US
Practice Address - Phone:713-442-2179
Practice Address - Fax:713-442-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195683336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX464896Medicaid
4586597OtherOTHER ID NUMBER-COMMERCIAL NUMBER