Provider Demographics
NPI:1083840300
Name:KISKEYA INVESTMENT GROUP LLC
Entity Type:Organization
Organization Name:KISKEYA INVESTMENT GROUP LLC
Other - Org Name:KISKEYA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-632-0601
Mailing Address - Street 1:3880 W BROWARD BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1058
Mailing Address - Country:US
Mailing Address - Phone:954-990-4217
Mailing Address - Fax:954-990-4263
Practice Address - Street 1:3880 W BROWARD BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1058
Practice Address - Country:US
Practice Address - Phone:954-990-4217
Practice Address - Fax:954-990-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH240863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1045954OtherNCPDP PROVIDER IDENTIFICATION NUMBER