Provider Demographics
NPI:1902892763
Name:KEGAN'S INC
Entity Type:Organization
Organization Name:KEGAN'S INC
Other - Org Name:LEONARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KEGANS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-587-3363
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:122 W COLLINS
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-1229
Mailing Address - Country:US
Mailing Address - Phone:903-587-3363
Mailing Address - Fax:903-587-2714
Practice Address - Street 1:122 W COLLINS ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-2642
Practice Address - Country:US
Practice Address - Phone:903-587-3363
Practice Address - Fax:903-587-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04872332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091635501Medicaid
TX013678001Medicaid
TX013678001Medicaid