1245237502 NPI number — KELSON DRUG INC

Table of content: (NPI 1245237502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245237502 NPI number — KELSON DRUG INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELSON DRUG INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245237502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3008 JEFFERSON ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MARIANNA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32446-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-526-2839
Provider Business Mailing Address Fax Number:
850-526-5259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3008 JEFFERSON ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MARIANNA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32446-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-526-2839
Provider Business Practice Location Address Fax Number:
850-526-5259
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TEMPLES
Authorized Official First Name:
LEE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT, PHARMACY MANAGER
Authorized Official Telephone Number:
850-526-2839

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1041754 . This is a "NABP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 121109800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com