Provider Demographics
NPI:1538948211
Name:UPTOWN PHARMACY OF KINGMAN , INC
Entity type:Organization
Organization Name:UPTOWN PHARMACY OF KINGMAN , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFFIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-2226
Mailing Address - Street 1:2820 E ANDY DEVINE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4203
Mailing Address - Country:US
Mailing Address - Phone:928-753-2226
Mailing Address - Fax:928-753-7649
Practice Address - Street 1:2820 E ANDY DEVINE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4203
Practice Address - Country:US
Practice Address - Phone:928-753-2226
Practice Address - Fax:928-753-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy