Kingdom Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP482480 Issued in PA

Legal business name

KINGDOM PHARMACY LLC

Doing business as

Kingdom Pharmacy

Practice address

9014 W Chester Pike
Upper Darby, PA 19082-2606

Phone

(484) 455-7915

Fax

(484) 455-7923

NPI assigned

May 21, 2014

Organization subpart

No

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

Authorized official

Name

Martine KouahouNPI 1588365498

Title

Manager

Phone

(484) 455-7915

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kingdom Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Martine Kouahou, PHARMD

  • Pharmacist
  • Upper Darby, PA
  • NPI 1588365498
  NPD (past) Authorized official

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

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1972915189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9014 W CHESTER PIKE",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822606",
            "telephone_number": "484-455-7915",
            "fax_number": "484-455-7923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9014 W CHESTER PIKE",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822606",
            "telephone_number": "484-455-7915",
            "fax_number": "484-455-7923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-21",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "KOUAHOU",
        "authorized_official_first_name": "MARTINE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "484-455-7915"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029193710001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2145885",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingdom Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keystone Pain Management
• Khogali Transport
• Anquinette Monique Kimble, MSW
• Roy R. Kinder Jr., MD
• Hanniel King, LCSW
• Kings Photography'S LLC
• Daniel J. Klein, DC
• Grady Knight
• Knipel Associates LLC
• Daniel Edward Knipel, O.D.

• Community/Retail Pharmacy in Upper Darby, PA
• Providers in Upper Darby, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.