1104271873 NPI number — KD RX LLC

Table of content: (NPI 1104271873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104271873 NPI number — KD RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KD RX LLC
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:
Provider Other Organization Name Type Code:
6
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:
1104271873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4644 W GANDY BLVD
Provider Second Line Business Mailing Address:
UNIT 4
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33611-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-605-0055
Provider Business Mailing Address Fax Number:
813-605-0099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4644 W GANDY BLVD
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33611-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-605-0055
Provider Business Practice Location Address Fax Number:
813-605-0099
Provider Enumeration Date:
04/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
FALGUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, RPH, AO
Authorized Official Telephone Number:
813-605-0055

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH30097 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 018841500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2159847 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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