Provider Demographics
NPI:1922101062
Name:K C DRUGS
Entity Type:Organization
Organization Name:K C DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WC
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-787-2345
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:HEMPHILL
Mailing Address - State:TX
Mailing Address - Zip Code:75948-0790
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HWY 83 S HEMPHILL
Practice Address - Street 2:
Practice Address - City:HEMPHILL
Practice Address - State:TX
Practice Address - Zip Code:75948
Practice Address - Country:US
Practice Address - Phone:409-787-2345
Practice Address - Fax:409-787-2345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K C DRUGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10314333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1280968Medicaid
4570784OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TX142502Medicaid