Provider Demographics
NPI:1538540042
Name:KRIEGHOFF, FLOYD (RPH)
Entity type:Individual
Prefix:
First Name:FLOYD
Middle Name:
Last Name:KRIEGHOFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2327
Mailing Address - Country:US
Mailing Address - Phone:903-832-2258
Mailing Address - Fax:903-832-2451
Practice Address - Street 1:2610 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2327
Practice Address - Country:US
Practice Address - Phone:903-832-2258
Practice Address - Fax:903-832-2451
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42244183500000X, 183500000X
OH03112372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX463944Medicaid
TX1012120063Medicare NSC