KV Medical LLC.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

KV MEDICAL LLC.

Doing business as

Broadway & Main Pharmacy

Practice address

136 E. Broadway
Newport, TN 37821-2323

Phone

(423) 720-9777

Fax

(423) 720-9778

NPI assigned

Jan 4, 2019

Organization subpart

No

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

Authorized official

Name

Justin Kickliter

Title

Pic

Phone

(423) 720-9777

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Broadway & Main Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Broadway Main Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• KV Medical LLC.

  • Long Term Care Pharmacy
  • Newport, TN
  • NPI 1144927385
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Bruce Boggs II, PHARM.D.

  • Pharmacotherapy Pharmacist
  • Middlesboro, KY
  • NPI 1346353828
  NPD

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

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1073086807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 E. BROADWAY",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378212323",
            "telephone_number": "423-720-9777",
            "fax_number": "423-720-9778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 E. BROADWAY",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378212323",
            "telephone_number": "423-720-9777",
            "fax_number": "423-720-9778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KV MEDICAL LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-04",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "KICKLITER",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "423-720-9777"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q046150",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BROADWAY & MAIN LICENSE",
            "identifier": "6866",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway & Main Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kesley Kirk, PT, DPT
• Catrina Knight
• Kristie Hawk Knight, PHARMD
• Chloe Kohn, BA
• Jamielee Kreutz
• KV Medical LLC.
• Lakeway Pharmacy Consultants PLLC
• Krystal Lynn Lamb, NP
• Melissa Rae Lamb, APRN,BC
• Reagan L Lamont, OTR/L

• Community/Retail Pharmacy in Newport, TN
• Providers in Newport, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.