NPIMap

Organization Active NPI

KS Pharm LLC

Doing business as Kelsey Pharmacy

  • Community/Retail Pharmacy
  • Shenandoah, TX
National Provider Identifier
1437210507
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KS PHARM LLC
Doing business as
Kelsey Pharmacy
Practice address
106 Vision Park Blvd
Shenandoah, TX 77384
Phone
(713) 442-1975
Fax
(713) 442-1995
NPI assigned
Dec 13, 2006
Last updated
Mar 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Authorized official

Name
Lance Aaron Jordan, R.PHNPI 1851674642
Title
Director of Pharmacy
Phone
(713) 442-5251

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

106 Vision Park Blvd
Shenandoah, TX 77384

Mailing address

106 Vision Park Blvd
Shenandoah, TX 77384
Phone (713) 442-1975

Other identifiers 2

IdentifierTypeStateIssuer
4532594OtherOTHER ID NUMBER-COMMERCIAL NUMBER
470967MedicaidTX

Other names 1

  • Kelsey Pharmacy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL kathleen.russell@kelsey-seybold.com Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
KS Pharm LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

106 Vision Park Blvd
Shenandoah, TX 77384
Phone (713) 442-1800

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1437210507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 VISION PARK BLVD",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "77384",
            "telephone_number": "713-442-1975",
            "fax_number": "713-442-1995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 VISION PARK BLVD",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "77384",
            "telephone_number": "713-442-1975",
            "fax_number": "713-442-1995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KS PHARM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "LANCE",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "713-442-5251",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4532594",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470967",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kathleen.russell@kelsey-seybold.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "106 Vision Park Blvd",
            "city": "Shenandoah",
            "state": "TX",
            "country_code": "US",
            "postal_code": "77384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kelsey Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kelsey Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shenandoah, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; 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.