The KG Group LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

THE KG GROUP LLC

Doing business as

Shadow Creek Pharmacy

Practice address

11710 Broadway St Ste 120
Pearland, TX 77584-4046

Phone

(832) 617-8080

Fax

(832) 717-2391

NPI assigned

Mar 28, 2018

Last updated

May 21, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kwame AlbertNPI 1336724103

Title

Owner

Phone

(832) 617-8080

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shadow Creek Pharmacy Doing business as

Locations

Practitioners 2

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.

• Kwame Albert, CPHT

  • Pharmacy Technician
  • Pearland, TX
  • NPI 1336724103
  NPD Authorized official
• Gwendolyn Everage, RPH

  • Pharmacist
  • Pearland, TX
  • NPI 1770168478
  NPD (past)

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558396800000",
    "number": "1104321371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11408 EASTON SPRINGS DR",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775842518",
            "telephone_number": "281-303-7551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11710 BROADWAY ST STE 120",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775844046",
            "telephone_number": "832-617-8080",
            "fax_number": "832-717-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KG GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2019-05-21",
        "status": "A",
        "authorized_official_last_name": "ALBERT",
        "authorized_official_first_name": "KWAME",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-617-8080"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176871",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shadow Creek Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shadow Creek Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Pearland, TX
• Providers in Pearland, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.