Uptown Pharmacy of Kingman , Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

Y007029 Issued in AZ

Legal business name

UPTOWN PHARMACY OF KINGMAN , INC

Doing business as

Uptown Drug

Practice address

2820 E Andy Devine Ave
Kingman, AZ 86401-4203

Phone

(928) 753-2226

Fax

(928) 753-7649

NPI assigned

Aug 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chris Howard Proffit, B.S. PHARMACYNPI 1811765639

Title

Owner

Phone

(928) 753-2226

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• UPTOWN DRUG Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Uptown Pharmacy of Kingman , Inc

  dba Uptown Drug Golden Valley

  • Community/Retail Pharmacy
  • Golden Valley, AZ
  • NPI 1376554949

  1658499793

  Same PAC ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chris Proffit, RPH

  • Pharmacist
  • Kingman, AZ
  • NPI 1811765639
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1003827676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 E ANDY DEVINE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014203",
            "telephone_number": "928-753-2226",
            "fax_number": "928-753-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 E ANDY DEVINE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014203",
            "telephone_number": "928-753-2226",
            "fax_number": "928-753-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPTOWN PHARMACY OF KINGMAN , INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "PROFFIT",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-753-2226",
        "authorized_official_credential": "B.S. PHARMACY"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y007029",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235636",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1988343",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPTOWN DRUG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UPTOWN DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Panayiota Tsokas, SCHOOL COUNSELOR
• Robert Alan Tucker, PHARM.D.
• Twin Peaks Medical Associates PLLC (Fastrax Urgent Care Center)
• Tyler T Tatton DDS PC
• Barry J Uldrikson, D.D.S.
• Uptown Pharmacy of Kingman , Inc (Uptown Drug)
• Uptown Pharmacy of Kingman , Inc (Uptown Drug North)
• Uptown Pharmacy of Kingman , Inc (Uptown Home Medical, Uptown Drug)
• Nathaniel Urquhart, DMD
• Lynne Valentine, R.N.

• Community/Retail Pharmacy in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Community/Retail Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.