Provider Demographics
NPI:1235112954
Name:KHK OPERATING CORP
Entity Type:Organization
Organization Name:KHK OPERATING CORP
Other - Org Name:GUSAR'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-794-5757
Mailing Address - Street 1:458 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1732
Mailing Address - Country:US
Mailing Address - Phone:845-794-5757
Mailing Address - Fax:845-794-3570
Practice Address - Street 1:458 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1732
Practice Address - Country:US
Practice Address - Phone:845-794-5757
Practice Address - Fax:845-794-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021919333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01442511Medicaid
NY3341435OtherNABP
0774020001Medicare NSC