Provider Demographics
NPI:1649575424
Name:KINGSLEY PHARMACY
Entity Type:Organization
Organization Name:KINGSLEY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-664-6333
Mailing Address - Street 1:2626 S LOOP W STE 115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2648
Mailing Address - Country:US
Mailing Address - Phone:713-664-6333
Mailing Address - Fax:713-664-6336
Practice Address - Street 1:2626 S LOOP W STE 115
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2648
Practice Address - Country:US
Practice Address - Phone:713-664-6333
Practice Address - Fax:713-664-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy