Provider Demographics
NPI:1851522155
Name:KPH-CONSOLIDATION, INC
Entity Type:Organization
Organization Name:KPH-CONSOLIDATION, INC
Other - Org Name:NORTH CYPRESS VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-206-6785
Mailing Address - Street 1:21212 NORTHWEST FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5972
Mailing Address - Country:US
Mailing Address - Phone:832-912-6210
Mailing Address - Fax:832-912-6215
Practice Address - Street 1:21212 NORTHWEST FWY STE 101
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5972
Practice Address - Country:US
Practice Address - Phone:832-912-6210
Practice Address - Fax:832-912-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
TX265313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121188OtherPK