Provider Demographics
NPI:1023398443
Name:KB PHARMACY
Entity type:Organization
Organization Name:KB PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:270-967-9007
Mailing Address - Street 1:320 S MAIN ST
Mailing Address - Street 2:PO BOX 437
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064-1513
Mailing Address - Country:US
Mailing Address - Phone:270-967-9007
Mailing Address - Fax:
Practice Address - Street 1:320 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1513
Practice Address - Country:US
Practice Address - Phone:270-967-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO74653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPO7465OtherLICENSE