Provider Demographics
NPI:1235236191
Name:KYFFIN PHARMACY INC
Entity Type:Organization
Organization Name:KYFFIN PHARMACY INC
Other - Org Name:KYFFIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZEFFREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-781-3219
Mailing Address - Street 1:6000 WOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6310
Mailing Address - Country:US
Mailing Address - Phone:818-781-3219
Mailing Address - Fax:818-988-2980
Practice Address - Street 1:6000 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6310
Practice Address - Country:US
Practice Address - Phone:818-781-3219
Practice Address - Fax:818-988-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA460230Medicaid
CAPHA460230Medicaid