Provider Demographics
NPI:1669714267
Name:KPM SPECIALTY HOLDINGS INC
Entity type:Organization
Organization Name:KPM SPECIALTY HOLDINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-619-3407
Mailing Address - Street 1:8700 CENTRAL AVE STE 301
Mailing Address - Street 2:OMNI MEDICAL BLDG
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4853
Mailing Address - Country:US
Mailing Address - Phone:240-619-3407
Mailing Address - Fax:202-318-0440
Practice Address - Street 1:8700 CENTRAL AVE STE 301
Practice Address - Street 2:OMNI MEDICAL BLDG
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4853
Practice Address - Country:US
Practice Address - Phone:240-619-3407
Practice Address - Fax:202-318-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336M0003X
MDPW03763336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137203OtherNCPDP PROVIDER IDENTIFICATION NUMBER