| Organization Name: | KMART PHARMACY |
| NPI Number: | 1104236843 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMBRISH N PATEL (PHARMACY MANAGER) |
| Mailing Address: | 1205 E Pine St Deming |
| State: | NM US |
| Postal Code: | 880307038 |
| Phone Number: | 5755449008 |
| Fax Number: | 5755444465 |
| NPI Enumeration Date: | 05/03/2014 |
| NPI Last Update Date: | 05/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0003X |
| License Number: | RP00007752 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Community/Retail Pharmacy |
| Taxonomy Definition: | A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |