NPIMap

Organization Active NPI

KPH Healthcare Services, Inc.

Doing business as Kinney Drugs #101

  • Community/Retail Pharmacy
  • Waterbury, VT
National Provider Identifier
1770814527
Registry record updated Jul 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
038-0063144 Issued in VT
Legal business name
KPH HEALTHCARE SERVICES, INC.
Doing business as
Kinney Drugs #101
Practice address
80 S Main St
Waterbury, VT 05676-1553
Phone
(802) 244-8458
Fax
(802) 244-1882
NPI assigned
Jan 19, 2010
Last updated
Jul 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2024

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)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 038-0063144 VT Primary

Addresses

Primary practice location

80 S Main St
Waterbury, VT 05676-1553

Mailing address

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

Other names 1

  • Kinney Drugs #101 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930034320 VT DME Supplier - Pharmacy 9830217637 Practice locations: Waterbury, VT
O20110119001247 VT Part B Supplier - Mass Immunization (Roster Biller Only) 9830217637 23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cambridge, VT; Waterbury, VT; Vergennes, VT; South Burlington, VT; Shelburne, VT; Saint Johnsbury, VT; Saint Albans, VT; Randolph, VT…

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

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
47D2235432Kinney Drugs #10180 South Main St, Waterbury, VT 05676Certificate of waiverSep 8, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kinney Drugs #10180 S Main St, Waterbury, VT 05676-1553(802) 244-8458 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

National Provider Directory

National Provider Directory
Tax ID family
Kinney Drugs Inc 2388 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Member of 1

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

Locations

80 S Main St
Waterbury, VT 05676
Phone (802) 244-8458

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.

FacilityTypeRoleSince
Home Life Healthcare, Corp.Hoffman Estates, IL, CCN 148166 Home health agency 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020

NPI Registry JSON

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

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720051200000",
    "number": "1770814527",
    "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": "80 S MAIN ST",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761553",
            "telephone_number": "802-244-8458",
            "fax_number": "802-244-1882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KPH HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "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": "VT",
            "license": "038-0063144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kinney Drugs #101",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterbury, VT

Sources for this page

Verify at the official NPI Registry.