1235236191 NPI number — KYFFIN PHARMACY INC

Table of content: (NPI 1235236191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235236191 NPI number — KYFFIN PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KYFFIN PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KYFFIN PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235236191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 WOODMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91401-6310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-781-3219
Provider Business Mailing Address Fax Number:
818-988-2980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 WOODMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91401-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-781-3219
Provider Business Practice Location Address Fax Number:
818-988-2980
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZEFFREN
Authorized Official First Name:
MIRA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
818-781-3219

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PHY46023 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA460230 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".