Provider Demographics
NPI:1104859800
Name:KKN PHARMACY CORPORATION
Entity Type:Organization
Organization Name:KKN PHARMACY CORPORATION
Other - Org Name:THE DRUGGIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-643-0740
Mailing Address - Street 1:27881 LA PAZ RD STE E
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3933
Mailing Address - Country:US
Mailing Address - Phone:949-643-0740
Mailing Address - Fax:949-643-2287
Practice Address - Street 1:27881 LA PAZ RD STE E
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3933
Practice Address - Country:US
Practice Address - Phone:949-643-0740
Practice Address - Fax:949-643-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CA517533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144868OtherPK
2144868OtherPK