NPIMap

Organization Active NPI

KPH Healthcare Services, Inc.

  • Community/Retail Pharmacy
  • St Johnsville, NY
National Provider Identifier
1154438331
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KPH HEALTHCARE SERVICES, INC.
Practice address
12 Park PL
St Johnsville, NY 13452-1332
Phone
(518) 554-5466
Fax
(518) 554-5467
NPI assigned
Aug 24, 2006
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 20

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

Member of 1

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

Practitioners 4

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
33D2186230Kinney Drugs No 2512 Park Place, Saint Johnsville, NY 13452Certificate of waiverMar 26, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
KPH Healthcare Services Inc12 Park PL, Saint Johnsville, NY 13452-1332(518) 554-5466 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 NY2 enrollments

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

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20100930052227 NY DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 9830217637 Practice locations: Saint Johnsville, NY
O20110921000274 NY Part B Supplier - Mass Immunization (Roster Biller Only) 9830217637 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Kinney Drugs Inc 26 (87 organizations share this tax ID)

Locations

12 Park Pl
St Johnsville, NY 13452
Phone (518) 554-5466

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 017742 NY
Community/Retail Pharmacy 3336C0003X Primary

Addresses

NPPES NPI Registry

Primary practice location

12 Park PL
St Johnsville, NY 13452-1332

Mailing address

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

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
00761793MedicaidNY
3376236OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

NPPES NPI Registry
  • Kinney Drugs#25 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": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1154438331",
    "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": "12 PARK PL",
            "city": "ST JOHNSVILLE",
            "state": "NY",
            "postal_code": "134521332",
            "telephone_number": "518-554-5466",
            "fax_number": "518-554-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPH HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "017742",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00761793",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3376236",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kinney Drugs#25",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Johnsville, NY

Sources for this page

Verify at the official NPI Registry.