Provider Demographics
NPI:1255047825
Name:KINGSTON HEALTHCARE CONSULTING, LLC
Entity type:Organization
Organization Name:KINGSTON HEALTHCARE CONSULTING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVERILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:904-477-3853
Mailing Address - Street 1:1282 CHESTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030
Mailing Address - Country:US
Mailing Address - Phone:904-477-3853
Mailing Address - Fax:224-252-3914
Practice Address - Street 1:2702 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2407
Practice Address - Country:US
Practice Address - Phone:244-441-3008
Practice Address - Fax:224-441-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2024-12-11
Deactivation Date:2024-02-02
Deactivation Code:
Reactivation Date:2024-08-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy