Active NPI
KPH Healthcare Services, Inc.
- Community/Retail Pharmacy
- Syracuse, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 031503
- Legal business name
- KPH HEALTHCARE SERVICES, INC.
- Practice address
- 307 Nottingham Rd.
Syracuse, NY 13210 - Phone
- (315) 287-3600
- Fax
- (315) 287-3179
- NPI assigned
- Sep 14, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Elizabeth M Marlow
- Title
- Third Party Administrator
- Phone
- (315) 287-3600
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 031503 | NY | Primary |
Addresses
Primary practice location
307 Nottingham Rd.
Syracuse, NY 13210
Mailing address
29 E Main St
Gouverneur, NY 13642-1401
Phone (315) 287-3600
Other names 1
- Kinney Drugs #113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110921000274 | NY | Part B Supplier - Mass Immunization (Roster Biller Only) | 9830217637 | This NPI is an additional NPI on the enrollment |
| O20121228000469 | NY | DME Supplier - Pharmacy | 9830217637 | Practice locations: Syracuse, NY |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2122965 | Kinney Drugs 113 | Certificate of waiver | Mar 26, 2027 |
| 33D2232524 | KPH Healthcare Services Inc Mobile Lab | Certificate of waiver | Mar 26, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| KPH Healthcare Services Inc | 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 assignment |
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Home Life Healthcare, Corp. | Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2020 |
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Syracuse, NY
- NPI 1902135031
-
- Pharmacist
- Syracuse, NY
- NPI 1336421585
-
- Pharmacist
- Syracuse, NY
- NPI 1225401169
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347580800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1720051200000",
"number": "1376893529",
"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": "307 NOTTINGHAM RD.",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13210",
"telephone_number": "315-287-3600",
"fax_number": "315-287-3179"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KPH HEALTHCARE SERVICES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2012-09-14",
"last_updated": "2024-07-04",
"certification_date": "2024-07-04",
"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": "NY",
"license": "031503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Kinney Drugs #113",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.