Kilgore Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

KILGORE PHARMACY LLC

Practice address

1909 Main St
Haynesville, LA 71038-4907

Phone

(318) 624-1122

NPI assigned

Nov 7, 2023

Organization subpart

No

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

Authorized official

Name

Oluwafemi Adegboyega

Title

Owner

Phone

(708) 945-0269

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Kilgore Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Kilgore Pharmacy LLC

  dba Killgore Pharmacy

  • Community/Retail Pharmacy
  • Haynesville, LA
  • NPI 1972202067
  NPD tax ID

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

{
    "created_epoch": "1699315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746230400000",
    "number": "1902670243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 MAIN ST",
            "city": "HAYNESVILLE",
            "state": "LA",
            "postal_code": "710384907",
            "telephone_number": "318-624-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 MAIN ST",
            "city": "HAYNESVILLE",
            "state": "LA",
            "postal_code": "710384907",
            "telephone_number": "318-624-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILGORE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-07",
        "last_updated": "2025-05-03",
        "certification_date": "2025-05-03",
        "status": "A",
        "authorized_official_last_name": "ADEGBOYEGA",
        "authorized_official_first_name": "OLUWAFEMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-945-0269"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2210017",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Raines Community Health Center, Inc
• Alice J Fanning, FNP
• Paula Herrington
• Homer Memorial Hospital (Butler-Abshire Medical Clinic)
• James K Killgore Inc (Killgores Pharmacy)
• Kilgore Pharmacy LLC (Killgore Pharmacy)
• Jacinda Meadors
• Sandra Killgore Meisler, PH
• Moseley E Mellinger, LPC, NCC
• Samantha Modisette

• Long Term Care Pharmacy in Haynesville, LA
• Providers in Haynesville, LA by specialty
• Long Term Care Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2025; 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.