Provider Demographics
NPI:1194018911
Name:K.I.S. PHARMACY, INC.
Entity Type:Organization
Organization Name:K.I.S. PHARMACY, INC.
Other - Org Name:AVE X-DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:917-975-5125
Mailing Address - Street 1:3050 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1204
Mailing Address - Country:US
Mailing Address - Phone:347-497-7333
Mailing Address - Fax:
Practice Address - Street 1:3050 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1204
Practice Address - Country:US
Practice Address - Phone:347-497-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty