Provider Demographics
NPI:1265418792
Name:KIOWA PHARMACY, INC.
Entity type:Organization
Organization Name:KIOWA PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HINDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-893-0677
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2407
Mailing Address - Country:US
Mailing Address - Phone:903-893-0677
Mailing Address - Fax:903-893-3639
Practice Address - Street 1:1201 OLIVE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240
Practice Address - Country:US
Practice Address - Phone:940-668-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13583333600000X, 332B00000X, 3336C0004X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143598Medicaid
TX0677445-03Medicaid
TX143598Medicaid