KPH Healthcare Services, Inc.
Organization Active NPI Community/Retail Pharmacy · Tully, NY
NPI 1992812176 · NPPES record last updated Jul 4, 2024
Key facts
- NPI
- 1992812176
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- KPH HEALTHCARE SERVICES, INC.
- Practice address
- 596 Route 11
Tully, NY 13159 - Phone
- (315) 696-8796
- Fax
- (315) 696-6145
- NPI assigned
- Aug 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Elizabeth M Marlow
- Title
- Third Party Administrator
- Phone
- (315) 287-3600
Corporate family (same tax ID) 12
Member of 1
Practitioners 4
-
Rebecca Horn, R.PH.
-
Lindsay A Schmidt, PHARM D
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kinney Drugs #74 |
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 assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Home Life Healthcare, Corp. |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930035761 | NY | DME Supplier - Pharmacy |
9830217637 | Practice locations: Tully, NY |
| O20110921000274 | NY | Part B Supplier - Mass Immunization (Roster Biller Only) | 9830217637 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Kinney Drugs Inc 26
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 026934 | NY | |
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
596 Route 11
Tully, NY 13159
Mailing address
29 E Main St
Gouverneur, NY 13642-1401
Phone (315) 287-3600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02620419 | Medicaid | NY | |
| 3340255 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- Kinney Drugs #74
Other providers in Tully, NY
- Morgan Hiltbrand
- Taylor Anne Hoige
- Susan Krista Ives
- John Cognato PT PC
- Cheryl K Karpinski
- Kadene Elizabeth Limmer
- Anthony G Lombardo
- Matthew Scheuer LCSW PLLC
- Jan Mary Mead
- Ahmad M Mehdi
All providers in Tully, NY · Community/Retail Pharmacy in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.