Active NPI
West Kingman Pharmacy LLC
- Community/Retail Pharmacy
- Kingman, AZ
National Provider Identifier
1760878821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- WEST KINGMAN PHARMACY LLC
- Practice address
- 3135 N Stockton Hill Rd
Kingman, AZ 86401 - Phone
- (928) 718-5418
- Fax
- (928) 718-5419
- NPI assigned
- Apr 15, 2015
- 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
- Kassie Lynn Villa, CPHT
- Title
- Pharmacy Manager
- Phone
- (928) 377-1350
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
3135 N Stockton Hill Rd
Kingman, AZ 86401
Mailing address
1099 E Sunrise Ave
Kingman, AZ 86401-6825
Phone (928) 718-5418
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2151367 | Other | PK | |
| 192215 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210830001222 | AZ | Part B Supplier - Pharmacy | 5991100950 | Practice locations: Kingman, AZ |
National Provider Directory
National Provider Directory- Tax ID family
- West Kingman Pharmacy LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Kingman, AZ
- NPI 1245357706
Locations
3135 N Stockton Hill Rd
Kingman, AZ 86401
Phone (928) 377-1350
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429056000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1565568000000",
"number": "1760878821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1099 E SUNRISE AVE",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864016825",
"telephone_number": "928-718-5418",
"fax_number": "928-718-5419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3135 N STOCKTON HILL RD",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "86401",
"telephone_number": "928-718-5418",
"fax_number": "928-718-5419"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WEST KINGMAN PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-04-15",
"last_updated": "2019-08-12",
"status": "A",
"authorized_official_last_name": "VILLA",
"authorized_official_first_name": "KASSIE",
"authorized_official_middle_name": "LYNN",
"authorized_official_title_or_position": "PHARMACY MANAGER",
"authorized_official_telephone_number": "928-377-1350",
"authorized_official_credential": "CPHT"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2151367",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "192215",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.