Provider Demographics
NPI:1962914234
Name:KSC, INC
Entity type:Organization
Organization Name:KSC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-622-8888
Mailing Address - Street 1:526 HIGHWAY 52 BYP W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1614
Mailing Address - Country:US
Mailing Address - Phone:615-666-4444
Mailing Address - Fax:615-666-2222
Practice Address - Street 1:526 HIGHWAY 52 BYP W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1614
Practice Address - Country:US
Practice Address - Phone:615-666-4444
Practice Address - Fax:615-666-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy