Provider Demographics
NPI:1003113952
Name:GKA INC
Entity Type:Organization
Organization Name:GKA INC
Other - Org Name:PRO HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDKHOROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-507-7775
Mailing Address - Street 1:8412 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7339
Mailing Address - Country:US
Mailing Address - Phone:718-507-7775
Mailing Address - Fax:718-507-7781
Practice Address - Street 1:8412 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7339
Practice Address - Country:US
Practice Address - Phone:718-507-7775
Practice Address - Fax:718-507-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0306293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5802485OtherNCPDP PROVIDER IDENTIFICATION NUMBER