NPIMap

Organization Active NPI

KPH Healthcare Services, Inc.

  • Community/Retail Pharmacy
  • Shelburne, VT
National Provider Identifier
1104183524
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0380085215 Issued in VT
Legal business name
KPH HEALTHCARE SERVICES, INC.
Practice address
47 Executive Drive
Shelburne, VT 05482
Phone
(802) 985-0008
Fax
(802) 985-0011
NPI assigned
Apr 23, 2012
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Elizabeth M Marlow
Title
Third Party Administrator
Phone
(315) 287-3600

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 6

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
47D2235447Kinney Drugs #10747 Executive Dr, Shelburne, VT 05482Certificate of waiverSep 8, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kinney Drugs #10747 Executive Dr, Shelburne, VT 05482-7142(802) 985-0008 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Wa… Accepts assignmentParticipating since Mar 1, 2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110119001247 VT Part B Supplier - Mass Immunization (Roster Biller Only) 9830217637 23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cambridge, VT; Waterbury, VT; Vergennes, VT; South Burlington, VT; Shelburne, VT; Saint Johnsbury, VT; Saint Albans, VT; Randolph, VT…
O20120628000184 VT DME Supplier - Pharmacy 9830217637 Practice locations: Shelburne, VT

All facility ownership & control disclosures 1

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Home Life Healthcare, Corp.Hoffman Estates, IL, CCN 148166 Home health agency 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020

National Provider Directory

National Provider Directory
Tax ID family
Kinney Drugs Inc 2687 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 0380085215 VT Primary

Addresses

NPPES NPI Registry

Primary practice location

47 Executive Drive
Shelburne, VT 05482

Mailing address

29 E Main St
Gouverneur, NY 13642-1401
Phone (315) 287-3600

Other names 1

NPPES NPI Registry
  • Kinney Drugs #107 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 3, 2024.

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1104183524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 E MAIN ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421401",
            "telephone_number": "315-287-3600",
            "fax_number": "315-287-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 EXECUTIVE DRIVE",
            "city": "SHELBURNE",
            "state": "VT",
            "postal_code": "05482",
            "telephone_number": "802-985-0008",
            "fax_number": "802-985-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPH HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-23",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "MARLOW",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "THIRD PARTY ADMINISTRATOR",
        "authorized_official_telephone_number": "315-287-3600"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VT",
            "license": "0380085215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kinney Drugs #107",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelburne, VT

Sources for this page

Verify at the official NPI Registry.